Medicare PPO means Preferred Provider Organization, and represents the network of health providers that have agreed to see the plan’s members at contracted pre-negotiated rates.
A Medicare PPO is one type of Medicare Advantage plan that is one private alternative to Original Medicare. Why would you do this?
Well, in some cases, features of Medicare PPOs may include things like:
With so many options, when is choosing a Medicare Advantage PPO plan a good option? Again, that will vary depending on specific situations and needs. That’s another reason why having a licensed specialist help you with your enrollment can make your life so much easier. Here are a few perks of choosing a PPO over another plan like HMOs:
One disadvantage of PPO plans, however, is that since they are so much more flexible than other plans, they often have much higher premiums than HMO plans.
HMO, Health Maintenance Organization plans, or another form of Medicare Advantage plans, and are options offered by private insurance companies. The Medicare HMO plan is one of the most popular, partly because they generally come with much lower premiums than other plans. With these lower premiums, come some stipulations so it’s important to fully understand your options so that you can make the best choice for you.
As with other Medicare Advantage plans, HMO plans do still require you to be enrolled in Medicare Part A and Part B to be eligible.
Sometimes called Medicare managed care plans, HMO options are managed through a network of doctors and hospitals specific to that plan. Generally speaking, you will need to use in-network providers except in the case of an emergency.
In-network providers comprise a group of doctors in your local area. And, in most cases, you will need to see your in-network primary care provider (PCP) who will coordinate your care before referring you to specialists, if needed.
One thing to note is that HMO plans do not replace Medicare Part B. To participate in an HMO plan, you must be enrolled in both Part A and Part B, and live in the plan’s service area.
In addition to all the required benefits included in Part A and Part B such as hospital care, nursing care, hospice, lab tests, surgeries, outpatient care, medical equipment, Part B giveback, etc., Medicare Advantage plans can potentially provide you with additional benefits.
Some of these benefits, depending on the plan, may include things such as:
*Eligibility will depend on the plan and specific requirements of the providers in your area.
Schedule an appointment today with one of our specialists to discuss your individual needs to determine the best coverage and plans. Our agents can also fully explain enrollment periods, annual elections, open enrollment periods, and special election periods to help you throughout the enrollment process.
If you are a veteran, you’ll especially want to work closely with a knowledgeable insurance agent who is well-versed in working with veterans. Veterans fall into another special category because of options such as TRICARE and VA health coverage. You may think that Supplemental Insurance may not be needed if you are a veteran, yet in some cases the best option includes combining a Medicare Advantage plan with your other benefits.
Why? You want and need the confidence in knowing that you will be taken care of regardless of any potential health challenges you may face, particularly with the least burden to you and your family. When you have a health crisis, the last thing you should have to worry about is how you are going to pay the bills. But choosing the best plan or combination of plans is not a one-size-fits-all.
Here are a few benefits to combining your VA coverage with a Medicare Advantage plan:
Some of these benefits, depending on the plan, may include things such as:
*Eligibility will depend on the plan and specific requirements of the providers in your area.
Schedule an appointment today with one of our specialists to discuss your individual needs to determine the best coverage and plans. Our agents can also fully explain enrollment periods, annual elections, open enrollment periods, and special election periods to help you throughout the enrollment process.
If you suffer from a chronic condition that is severe or disabling, you may qualify for a Chronic Special Needs Plan. These plans provide coverage to people who suffer from chronic conditions that require coordination of care across primary providers, medical and mental health specialists, inpatient and outpatient facilities, and ancillary services providers.
Special Needs Plans provide benefits and services to people with certain health care needs or limited incomes. They have benefits, provider options, and formularies that are designed to meet the specific needs of the groups that qualify. These plans cover the same benefits that all Medicare Advantage Plans cover, primarily Part A hospital insurance and Part B medical insurance. Though, many SNPs have additional benefits included to cover extra services that members often need. For example, if a plan is designed for people who have a severe condition that often requires a hospital stay, an SNP could cover extra days in the hospital.
There are several ways to qualify for a Special Needs Plan. You may qualify due to a specific disease, unique health care needs, or limited income. If you qualify due to a chronic condition, you can join a Chronic Special Needs Plan (C-SNP). The chronic conditions that can qualify you for an SNP include:
If you are enrolled in a Chronic Special Needs Plan, you generally must seek care from doctors and other health care providers that are within the plan’s network.
SNP plans may require you to have a primary care doctor to coordinate your care, but this varies across plans. If you have a chronic condition, having a primary care doctor can make managing your condition much easier. Therefore, some plans require you to maintain a primary care provider.
Another important note is that all SNPs must provide Medicare prescription drug coverage. This means you won’t have to worry about finding other drug coverage.
If you qualify for Medicare and Medicaid, you can opt into a Dual Eligible Special Needs Medicare plan. These plans provide special coverage for people who are enrolled in both Medicare and Medicaid. They help people with the highest needs to cover their out-of-pocket costs for health care services.
If you fall into this category and are interested in acquiring dual eligible coverage, here’s what you need to know.
Special Needs Plans, or SNPs, provide benefits and services to people that have specific health care needs or limited incomes. These plans are tailored to meet the specific needs of their members. Everything from benefits to provider choices, to covered drugs, are all chosen with great care to ensure the best outcomes for plan participants.
If you are above age 65 and have certain health conditions or limited finances, you may be qualified for both federal and state public health insurance. Nearly 12 million Americans fall into this category, so if you’re one of them, don’t wait to enroll in a Dual Eligible Special Needs Plan (D-SNP). These private health plans coordinate care and benefits across Medicare, a federal program, and Medicaid, a state-level program.
D-SNPs are designed to keep you healthy at a low cost. They have $0 monthly premiums and cover everything that other Medicare Advantage plans are required to cover. Here is a list of benefits offered by D-SNPs:
You can get additional benefits, but not all D-SNPs offer them. An example is a dental coverage.
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