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Medicare Basics

Types of Medicare Advantage Plans

Medicare Advantage plans vary from provider to provider, so consider your medical needs carefully before choosing a plan. Review the details, including any fine print, to discover exactly what the plan covers and what it expects you to pay as far as co-pays and premiums. Look also at any restrictions listed to ensure your plan meets your needs.

Medicare Advantage plans are required to cover both Part A and Part B health care, but can also offer additional benefits. Here are the types of plans:

  1. Health Maintenance Organization (HMO) plans will only allow you to visit physicians and hospitals that are within the HMO network unless there is an emergency. However, HMOs can lower costs, making them (in some cases) less expensive than Medicare Parts A and B.
  2. Preferred Provider Organizations (PPOs)

     allow you to use doctors, hospitals, and specialists within the PPO network. However, you are permitted to use health providers outside of the network at an additional cost to you and without a referral.
  3. With a 

    Private Fee-for-Service (PFFS)

     plan, you are able to use any doctor or specialist, as long as they accept the terms, fees, and conditions of the PFFS. The plan chooses how much it will pay for the services, and you can spend more or less on PFFS plans than Medicare Parts A and B.
  4. A

    Medicare Medical Savings Account (MSA)

     plan combines a medical savings account with a high deductible. Medicare gives the plan an amount of money each year for your healthcare and the plan deposits this money into your account. You can use this money to pay for healthcare costs, even if they’re not covered by Medicare. If you use it for Medicare Part A and Medicare Part B services, you can count this towards your deductible. If you have used the money provided but have additional healthcare costs, you have to pay for the Medicare-covered services out-of-pocket. After you reach your deductible, the plan will cover Medicare-covered services.

Tips for Choosing Your Medicare Advantage Plan

Do not ignore the provider network. If you have a preexisting condition and have long-standing history with a doctor or other provider, make sure the plan’s network includes your preferred provider. Remember, these networks include physicians, labs, hospitals, clinics, and more.

If you take any prescription medications (statistics say that you do), review the plan’s drug coverage. Not every Medicare Advantage plan includes prescription coverage. What’s more, drug formularies (the list of prescription drugs covered by the plan) vary by provider and plan type. Look closely at coverage, the formulary, and co-pays for your prescriptions.

It’s also important to predict what you may need over the course of the plan year. How do you determine future needs? Consider advice from your last yearly wellness exam. Did your doctor warn you about high blood pressure, pre-diabetes, or similar chronic conditions? Most treatment plans for chronic conditions include prescriptions.