Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private insurance companies. Enrollees must still pay the Medicare Part B premium which is given to the private insurers in lieu of a premium, though some plans do charge an additional premium. In our area, there are many low cost options for the discerning shopper. Typically the plans combine hospital, medical and sometimes prescription benefits. Some even offer basic ancillary services like dental and eye exams, as well as fitness club memberships. In more recent years, many of these plans offer ancillary benefits which can include dental, vision, and hearing. We represent major carriers and offer free consultations to ascertain what program best serves your needs.
While there are many plans with a low premium, you must enroll in Part B with the associated cost. In the past, these plans were sold on the merits of their medical and prescription coverage, but the emphasis has shifted to all advertising promoting the “advantages” added on to the plans instead of the plans themselves. Beware that there are networks of both doctors and facilities as well as copays associated with these offerings. Prescription drug costs are NOT included in the maximum out pocket costs under these plans, so , remember to do your due diligence or call Healthcare Help and we will do it for you. We don’t just sell health insurance but we advocate for you as well.
Medicare recipients under the age of 65 may find the Medicare Advantage Plan more advantageous than Original Medicare with the prescription drug plan as it limits the costs of healthcare to a maximum out of pocket cost. Call Healthcare Help to shop for your benefit. Medicare supplement plans are NOT available to anyone under age 65 in some states so be aware if you enroll in the prescription plan with original Medicare only, you will be responsible for all the deductibles, copays of your hospital and medical coverage as well as the full 20% medical coverages after the deductible not covered by Medicare.
Health Maintenance Organization (HMO) Plans are generally the most restrictive in network for doctors, health care providers or hospitals with the exception of an emergency situation. Many also require a referral from a primary care doctor for tests or to see a specialist. We only have a couple of HMO’s restricted to specific hospital networks but check all your physician and facilities to ensure they participate in the plans network. Plans specify by county and individual provider and facility association. The only out of network coverage is through emergency services.
Medicare supplement insurance plans have been around as long as Medicare and each plan specifies which “gaps” they are covering as well as what your liability for each is. Medicare supplements are offered by insurance companies, not Medicare. The coverage under each type of plan is standardized through Medicare but the pricing and any added services are up to each independent carrier. Additionally, which supplements to offer and underwriting eligibility are under the purview of each company as well. The colored font on the supplement table corresponds to the same color depicted on the diagram above.
Preferred Provider Organization (PPO) Plans offer a larger network of doctors, hospitals and network providers but also offers less cost sharing for benefits within the network than outside. They will pay facilities and providers who are not in their network but at a greater cost to the consumer.
Private Fee For Service (PFFS) Plans are similar to Original Medicare because you can be serviced by any doctor, healthcare provider or hospital as long as they accept the plans payment terms.
Special Needs Plans (SNP) provide specialized healthcare for specific groups of people with certain chronic medical conditions, have both Medicare and Medicaid. Many of the private insurance companies offer more benefits than traditional Medicaid.