At Malhotra & Assoc. Insurance, we help clients who want more from their Medicare benefits but don’t know where to look. With our many years of experience, you are guaranteed to get the personalized care you need to determine which part of Medicare makes the most sense for your specific needs.
If you’re getting close to the age where you will be eligible for Medicare benefits, you are going to have to make a hard choice soon. This choice is between whether you will choose Original Medicare or Medicare Advantage (Medicare Part C). The decision will impact what benefits you have access to and it will also dictate the cost of your Medicare coverage.
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Medicare Advantage is the private insurance component of the Medicare program. Through Part C of Medicare, private insurance companies contract with Medicare to provide benefits to Medicare’s beneficiaries. Plans are not standardized, but they are regulated by the Social Security Administration.
The plans are unique compared to Original Medicare plans, because they offer benefits that are not available through Original Medicare. Which plans and benefits you will have access to depends on your location and sometimes your health condition.
There are a variety of different Medicare Advantage plan types. The type of plan you choose will dictate which health care providers you can see and how much those services will cost. It will also dictate whether you need to get a referral to see specialists and if you need to have a primary care physician.
The types of Medicare Advantage plans include:
Health Maintenance Organization (HMO) plans are the most common type of Medicare Advantage plan being sold at the moment. They are often the least expensive, though this is attributed to the fact that HMO plans are far more limited than their counterparts. With an HMO plan, you must have a primary care physician to coordinate your care and you need referrals to see specialists. As an HMO plan participant, you can only receive covered care from providers that are within your network. Exceptions aren’t typically made, and you can be charged far more if you see a provider that is outside of your network. Of course, in emergency situations, your coverage should still apply.
Preferred Provider Organization (PPO) plans are more flexible than HMO plans, but they are often more expensive too. These plans allow you to receive care from providers who are outside of your network, although at a higher cost than in-network providers. You don’t need a referral to see specialists under this plan, and you also won’t need to keep a primary care physician.
Private Fee-for-Service (PFFS) plans are similar to Original Medicare plans, in that they allow you to see nearly any approved provider. The difference, though, is that PFFS plans dictate the amount they will pay to the doctors or health care providers you see. If your provider does not accept those stated rates, your plan will not cover the service.
If you have special circumstances, such as a qualifying disability or dual eligibility, you can enroll in a Special Needs Plan. These plans are meant for people with chronic conditions and other specific disabilities. The costs vary depending on the coverage level, but you can find really useful benefits by shopping around in this category.
Now that you know what types of Medicare Advantage plans are available, it’s time to start shopping for the perfect coverage option. Our talented team at Malhotra & Assoc. Insurance is waiting for your call. Get in touch with us now to start comparing Medicare Advantage plans in your area.
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