You've probably heard about all the bells and whistles that Medicare Advantage plans offer. However, you might not know that not all these plans are created equal. In fact, almost no two plans are exactly the same. The most important distinction is the difference between the kinds of Medicare Advantage options.
There are six types of Part C plans in Arizona. Today, we'll go through a brief overview of how each one works.
HMO plans require members to get care within the plan's network of providers and facilities. If you enroll in an HMO plan, you'll need to choose a primary care physician (PCP) and get a referral from them if you wish to see a specialist. In addition, you may also need to submit prior authorizations for treatment and prescriptions. If you receive treatment from an out-of-network provider, your plan will not pay for those services except in emergencies.
While those are certainly limitations, many HMO plans have $0 premiums and include prescription drug coverage. If your HMO plan does not include prescription drug coverage, you are not allowed to enroll in a separate Part D plan.
PPO plans are very similar to HMO plans, but with differences that give enrollees more freedom. For example, you will not have to designate a primary care physician, nor will you have to get any specialist referrals.
PPO networks are generally larger than HMO networks, which opens up more options when choosing providers. Plus, you will have some benefits outside the PPO network; you just might have to pay more out-of-pocket. For example, you may have no copay for a contracted provider, but a $25 copay for a non-contracted provider.
There are quite a few $0 premium PPO plans in Arizona, and most include prescription drug coverage. Like the HMO plans, you cannot enroll in a stand-alone Part D plan if your PPO plan does not include drug coverage.
An HMO-POS plan combines features of the PPO and HMO options. Like the PPO plans, you will not have to choose a PCP or obtain referrals. You can also see some providers outside of the HMO network as long as you're willing to pay a little more out-of-pocket. The biggest difference between this and the PPO option is that these plans have a separate deductible for in-network versus out-of-network services.
Point-of-service plans are also very affordable in Arizona, and most include drug coverage.
If you can enroll in any of the other three options above, we would likely not recommend a PFFS plan because you'll pay more out-of-pocket for these plans, even if your premium is $0. If you have a PFFS plan, you can see any Medicare-approved provider. However, not all providers will accept the plan's payment terms, and they can choose to accept or deny the plan on a case-by-case basis. The PFFS plan will dictate how much to reimburse providers for services and how much you must pay for care.
Prescription drugs are not always included in PFFS plans, but you are allowed to enroll in a separate Part D plan if they are not included.
There are three different kinds of SNP plans: I-SNPs, D-SNPs, and C-SNPs. Each of these has its own eligibility requirements in addition to the standard Medicare Advantage requirement of first having Parts A and B. SNPs tailor their benefits to the individuals enrolled in the plan.
I-SNPs are for institutionalized individuals. D-SNPs are for people who are eligible for Medicare and either Medicaid or other government financial assistance. C-SNPs are for those who have chronic conditions, which include a long list of conditions and diseases.
SNPs include a drug formulary that is also tailored to the condition being treated.
The last kind of Medicare Advantage plan we need to talk about is a Medicare Savings Account or MSA. If you've ever been enrolled in an HSA (Health Savings Account), you'll be able to understand MSAs easily.
If you enroll in an MSA, you'll have a high deductible - usually several thousand dollars. Just like every other kind of Part C plan, your benefits from Parts A and B will be rolled into your MSA. You'll have to pay out-of-pocket for all services before your MSA plan begins to contribute.
The great thing about MSA plans is that they are always premium-free. In addition, your plan's carrier will make an annual deposit into an MSA account. You can use these funds to help pay your deductible or save them. As long as you stay enrolled in your MSA, the funds roll over from one year to the next.
Medicare Advantage plans can be a great choice for many beneficiaries. They offer great premiums and tons of extra benefits. If you'd like to learn more about the plans in your area, call Local Medicare Specialists today!
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area which are United Healthcare, Aetna, Humana, Cigna, Blue Cross Blue Shield of Arizona, Centene, Devoted, and Scan. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.