Medicare Advantage Plan Types

Your Medicare HMO Specialist

Medicare HMO plans usually have lower premiums – at times as low as $0. That’s why they are immensely popular. Some of these plans (available in several Florida counties) even partially reimburse you for part of your Medicare Part B premium payment.

However, that is only possible if they are enrolled in Medicare Part B and Part A.

When you visit a doctor or a physician who is a part of the HMO network, the insurance company will reimburse for the care they provide for you.

A primary care physician (PCP) will be responsible for treating any health condition that you might have. If they aren’t able to do that, they will refer you to a specialist network.

Medicare HMO has virtually no out-of-network benefits, except for emergency medical attention. Remember that when you sign up for one!

Don’t spend hours and hours poring over each HMO plan to find the right one for you. Let the licensed FL Medicare Agency specialists come to your aid! From the size of the network, its star rating, history, which physicians participate in it, whether it has a built-in Medicare Part D drug formulary for your medications, to its service area, we have all the information about your plan. Call Florida Health Agency at 754-205-2005.

 

Features of Medicare HMOs

  • Besides having End-Stage Renal Failure, you can enroll in Medicare HMO during the proper election periods.
  • In many Florida Counties, there are specialized Medicare Advantage HMO plans for people who are eligible for both Medicare and Medicaid.
  • In many Florida Counties, there are specialized Medicare Advantage HMO plans for people with special Chronic Conditions, like Diabetes, Heart Disease, and COPD.
  • Everything from the premiums to benefit could change in the coming years, so review your Annual Notice of Change letter carefully.
  • Medicare Part D drug plans may be a part of your HMO plan. Therefore, always check the drug formulary and you might be able to buy your medications at a lower cost.
  • Your plan will tell you how much your health care provider can charge for a service, such as lab work, doctor’s visit, inpatient hospital care etc. You pay part of the cost in the form of co-pay or coinsurance.
  • Medicare Advantage plans receive a star rating from Medicare, which is based on current plan member feedback. While a five-star-rating is the highest rating, you will mostly come across 3 and 4-star plans. Ratings lower than 3 must be communicated to plan members so they can change out of it if they want to.

The Only Medicare PPO Expert You Need

Preferred Provider Organization (PPO) is similar to HMO in that you can reap the benefits of Medicare Parts A and B and sometimes even D. You must pay for Medicare Part B and the Medicare PPO premium – many of which are at NO cost! However, there are differences in this form of Medicare Health Insurance, as well, such as:

  • Lower co-pays when you visit healthcare providers who are in the network
  • No choosing of a primary care physician
  • No referrals needed to see specialists
  • Out-of-pocket expenses have a capped value

These features might vary from plan to plan, so do your research before enrolling in one!

 

Features of Medicare PPOs

  • Generally lower premiums as compared to Medicare Supplement Plans (Medigap)
  • Everything from the premiums to benefit could change in the coming years, so review your Annual Notice of Change letter carefully.
  • Medicare Part D drug plans may be a part of your HMO plan. Therefore, always check the drug formulary and you might be able to buy your medications at a lower cost. However, you can only get drug coverage from an integrated Part D plan – no separate part D drug plans in this case!
  • Your plan doesn’t dictate which doctor you should go to but you will be paying a higher cost, if you do – as well as pay a deductible (for out of network doctors and facilities) up front!
  • You pay in the form of copay as you go along
  • Enrollment in some Medicare Plans could include extra benefits like vision, dental, and health club membership. Read the rules before you avail those benefits.

Medicare PPO plans are not Medigap plans. They both offer different coverage and are not interchangeable!

If you find selecting the right plan to be tricky, then you shouldn’t have to do so alone! With the help of Florida Health Agency, you can reap the benefits from a plan that gives you access to the best healthcare providers and all your medications. Talk to us at 754-205-2005 and we will guide you through the whole procedure. We also love to answer questions, so ask away!

Excellent Medicare PFFS Expertise

Private-Fee-for-Service (PFFS) is available in select areas and requires their members to carry an ID card that must be presented before service. Like the other advantage Medicare Plans, this is not a Medicare Supplement plan!

Similarities with HMOs and PPOs include you paying the plan’s premiums, co-insurance, and pays. Differences include the absence of a limited network of providers.

Do not accept medical care until the provider has agreed to the payment terms and conditions outlined by your plan!

 

Features of Medicare PFFS

  • Your plan doesn’t dictate which doctor you should go to. All you have to do is present your card to a Medicare-participating provider. Ask if they will treat you and receive medical care immediately. These plans are perfect for you if you travel frequently.
  • You might be eligible for a separate Medicare Part D drug plan with your Medicare PFFS. Confirm to see if the drug plan should be integrated with your PFFS plan or if you must enroll in a separate drug plan for drug benefits and a separate PFFS for other medical needs.

PFFS plans are NOT Medicare Supplement Plans! Therefore, when you go to a provider who has no contract with your PFFS plan, they are only obligated to provide you with emergency care. You must discuss this with a healthcare provider if they agree to bill the plan for your care or not before receiving medical attention!

Rules regarding access to health care providers might complicate medical care for you, especially when you are in dire need of it! It is better to join forces with a good insurance agent who can help you determine the kind of coverage you have with your PFFS plan. Call Florida Health Agency at 754-205-2005 – we are the best at what we do!

Special Needs Plans (SNPs)

These plans are not available in every county or for every condition.

With an SNP, you must stick to the HMO format of Medicare Plans. They are only available to Medicare beneficiaries with certain health conditions. An SNP allows such a person to have their needs met in terms of specialist care for their condition. There are also some SNP plans designed specifically for people who qualify for both Medicare and Medicaid.

HMO-POS

A hybrid of the two plans, HMO and PPO, this plan enables you to use certain out-of-the-network providers in certain situations. For instance, if you are traveling, you can avail this opportunity and not have to pay more than if you had gone to an in-network provider.

However, it is always better to confirm which features work in what way to avoid unpleasant surprises later!

Keep in mind that each Medicare Advantage program has a certain service area. That is why; you can only join a plan that is available where you live. Our licensed health insurance agents will put together a checklist of items that you need your plan to have. They will then comb through all available plans to see which ones suit you best. Call 754-205-2005 to work with Florida Health Agency – we are friendly, professional, and knowledgeable!

Medical Savings Account Plans (MSAs)

These plans are NOT currently available in the state of Florida

MSAs make a sizeable fund put into a health savings account by Medicare available to you. You are free to spend them on health services that qualify for MSA, as well as, get insurance benefits.

Get Your Free Copy of the “Ultimate Guide to Medicare” video and eBook from Florida Medicare Agency!

This book helps you learn about the different parts of the Medicare program, including Medicare Part A and Part B (together, they are often called “Original Medicare”), Part C (often called “Medicare Advantage”) and Part D (the part of Medicare that covers your prescription medications).

Sign Up For Medicare

We understand that Medicare matters can get quite complicated. It is better to get help understanding Medicare before you sign up for a plan. With our help, you will have in-depth health insurance knowledge of the benefits offered by basic and supplement plans. Call 754-205-2005 right away for your Health Insurance Quotes!

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

Florida Health Agency is a licensed health insurance agency certified to sell Medicare products.
Medicare has neither reviewed nor endorsed this information.

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