Medicare Advantage Plans

Health Maintenance Organization (HMO)

This plan includes all the benefits of Medicare Part A and Part B.  Most plans include  prescription drug coverage

HMO plans use a network primary care provider to help coordinate care. HMO plans usually only pay for providers in the plan network.

Most have extra benefits you can't get from Medicare Parts A and B, such as:

Routine dental care and some comprehensive coverage

Eye exams, eyeglasses, and corrective lenses

Hearing tests and hearing aids

Wellness programs and fitness memberships

Over the counter drugs and supplies

Transportation

World wide coverage on some plans

 

Maximum out of pocket protection   

Premium costs vary, most are at zero premium.  It depends on your area.  There are no additional costs for the plan.

Preferred Provider Organization (PPO)

PPO Plans have network doctors, other health care providers, and hospitals. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network.  If a PPO does not have a Drug Plan included you cannot buy a stand-alone drug plan.  

Advantages

Do not have to select a Primary Care Physician.

Can choose any doctor but offers lower out-of-pocket costs to those within their preferred network.

No referral required to see a specialist.

More flexibility than other plan options.

Greater control over your choices as long as you don't mind paying for them.

May come with extra benefits like vision, dental, hearing, over the counter.  Some have premiums and some are at zero cost.  Depends on the carrier.

Private Fee-For-Service (PFFS)

A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.  

Some plans may have prescription drug coverage but if they don't, you can buy a stand-alone drug plan.  

If you join a PFFS Plan that has a network, you can also see any of the network providers who have agreed to always treat plan members. You can also choose an out-of-network doctor, hospital, or other providers, who accept the plan's terms, but your costs will usually be lower if you stay in the network

You would need to check your local area to see if a PFFS is available and what the plan will offer.

Health Maintenace Organization (HMO-SNP)

Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics.   There are three types of SNP's but it depends on your area.  Chronic Condition SNP, Institutional SNP, and Dual Eligible SNP.  

These plans design their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.

You are required to get your care and services from doctors or hospitals in the Medicare SNP network, except:

Emergency or urgent care, like the care you get for a sudden illness or

an injury that needs medical care right away

If you have End-Stage Renal Disease (ESRD) and need out-of-area dialysis

© 2020 by Jackson Life and Health Insurance.