Medicare Advantage plans are typically Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). As such they all have some sort of a network. HMOs require you to choose a Primary Care Physician (PCP) and get referrals from your PCP, if you require the care of a specialist. Moreover, the specialist is usually within the PCPs “circle”, which means they are part of the hospital, or doctor group associated with your PCP. PPOs allow you to use providers that are in network or out of network (it’s always a good practice to confirm with out of network providers that they will accept the plan).
When considering a Medicare Advantage plan, a good place to start it to ask your PCP, or their office staff, which Medicare Advantage plan(s) the doctor is contracted with. If you are looking to change doctors, we can assist by helping you choose from the updated provider directory with a particular plan. Additional discussion regarding specialists and hospitals may also be necessary before choosing a plan.
If you choose a Medicare Advantage plan that includes Part D, you do not need to take a separate Part D plan. In fact, if you do… you will be automatically disenrolled from your Medicare Advantage plan. The Part D piece is incorporated within the plan itself, making it very convenient. Medicare Advantage options are also available without Part D but should only be chosen after a detailed analysis, since future penalties could apply.
Most medical services incur a copayment. A typical copayment for a PCP would be $25 and a specialist somewhere between $35 to $50. Hospital stays always generate the highest copay somewhere between $275 and $400, with a cap on charges after day 5, or so.
One way plans differentiate against their competitors is to offer additional benefits. Samples of such benefits would be vision and dental benefits.
These plans offer multiple options, sometimes with a premium as low as $0 and as high as $200 per month. Generally, the lower premium plans have higher copayments and the higher premium plans have lower copayments. You can pay me now, or you can pay me later… Lastly, the premiums on Medicare Advantage plans vary by county.
Choosing the plan that’s right for you…
Through our needs analysis and discussions with you, we can help you choose the plan that works best for your lifestyle. Your medical and prescription needs, financial situation, need for flexibility and desire for peace of mind will all factor into the decision.
Once you’ve made a decision, we are available to you for yearly reviews during the Annual Election Period to ensure that you are always with the coverage that best meets your needs!
