Medicare Advantage Plans

If you are considering Medicare Advantage Plans in Washington or Oregon please contact Your Insurance Gal Stacey L. Johnson for a free consultation at (360) 771-1155. Stacey will help you make the smartest choices when it comes to enrolling in Medicare Advantage Plans.

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During open enrollment for Medicare plans each year, one of the areas to consider is

Medicare Advantage Plans.

There are 6 basic types of Medicare Advantage Plans, though not all types are available in all areas.

Basic types of Medicare Advantage Plans

  • Health Maintenance Organizations (HMO)
  • Preferred Provider Organizations (PPO)
  • Private Fee-for-Service Plans (PFFS)
  • Point of Service Plan (POS)
  • Special Needs Plans (SNP)
  • Medicare Savings Accounts (MSA)

There are limited enrollment opportunities for the Medicare Advantage Plans, in general these opportunities are either when you are new to Medicare Parts A and B. Or during each year’s annual election period or (AEP). During this time of AEP you are allowed to look at what is offered in the market place with the private sector insurance companies and evaluate what works best for your individual needs, lifestyle and budget.

Any private sector insurance company that offers a Medicare Advantage Plan must be contracted with Medicare and follow all Medicare regulations put in place.

Let’s look at some of the terminology:

A Medicare Advantage HMO, in general terms, is a plan that has a network of doctors, specialists, and hospitals that are members. You must stay “in the network” to be able to receive care. One other important point about  HMOs is that you usually have to have a referral to see a specialist. Additionally in most instances, if you opt for a Medicare Advantage HMO,  you can not receive medical services outside of the coverage area except in the case of a medical emergency.

A Medicare Advantage PPO may offer more flexibility and freedom of choice with doctors, specialists and hospitals. With a Medicare Advantage PPO there is generally a directory of “in-network” physicians and hospitals. Co-pays are usually lower when you see in network providers. For the most part, seeking medical services out of network will result in higher co-pays. However, most PPOs do not require a referral from your primary care doctor to see a specialists. If a specialists requires you to have a referral even though you have a PPO type plan, then it’s usually due to their particular clinic policies not due to your PPO plan.These instances are just doctor to doctor referrals and you wouldn’t have to wait on the approval from the insurance company.

A Medicare Advantage Private fee-for-Service plan PFFS is a complex plan that should be explored in detail prior to making a choice for this plan. It will be important to be sure that your doctors will accept the plans terms and conditions of the insurance company. If you are considering this option, we recommend discussing it in detail with an insurance professional that has comprehensive knowledge of Medicare Advantage plans.

A Medicare Advantage Point of Service POS is like a hybrid of the HMO and PPO plans. There is more flexibility then an HMO, but less than a PPO. Typically on a POS type plan you will see in-network physicians and hospitals. A POS does offer you the flexibility to seek services out of network at a higher rates.

Medicare Advantage Special Needs Plan SNP. These plans were created to work with those that have certain chronic conditions that can offer improved coordination and continuity of care. These plans can help monitoring your health status, and managing chronic diseases. The purpose of this plan is to assist in a better quality of care.

The Medicare Advantage Medical Savings Account MSA. These types of plans usually have much higher deductibles before you have medical services that will be paid for by the insurance company. You will have to meet your deductible before the insurance company begins paying. Only medical services that fall under Medicare Part A and B will apply to the deductible. Most MSA plans do not include Medicare Part D coverage. In the event that you also wanted drug coverage you would need to look at stand alone Medicare Part D plans available in your area.

For more detailed information visit

www.medicare.gov

Pros of Medicare Advantage plans

  1. There are no health questions asked. All Medicare Beneficiaries (except those with End Stage Renal Disease), including those that have Medicare due to a disability can apply for these guaranteed issues policies as long as you
    • Have Medicare Part A and Part B
    • Continue Part B premiums
    • Live or reside in the service area of a chosen plan at least 6 months out of the year
  1. Outside of these requirements you will get acceptance regardless of health conditions.
  2. Medicare Advantage plans tend to offer lower premiums than Medicare Supplements plans. Some areas offer $0.00 (zero) premium plans, though you must continue to pay into Medicare Part B.
  3. Some plans also include dental and vision benefits in addition to coverage for hospital stays, doctor visits, etc. Some plans even include free health club memberships

Cons of the Medicare Advantage Plans

  1. Most Medicare Advantage plans require a co-pay each time you see a doctor, or receive medical treatment, or visit a hospital.
  2. Medicare Advantage plans do not follow you if you move out of the service area, unless they are in the service area you move to. Though you will have the right to move to another plan.
  3. Not all Medicare plans work the same way. So contact us to find out what type of plan works best for you. It’s an important decision and our expertise is a free service and no cost to you.