Medicare Advantage Plans are one of the options available to you as a Medicare beneficiary. These “MA,” or “Part C,” plans are designed to give you more choices, but having so many decisions to make can seem overwhelming. With the right information at your fingertips, you can determine which healthcare plan will meet your individual needs and preferences.
You may elect to receive your Medicare Part A and Part B coverage through a Medicare Advantage Plan. These Medicare Advantage Plans provide you with at least the same coverage as Original Medicare, but might provide you with additional benefits, such as vision, dental, and prescription drug coverage.
If you decide that a Medicare Advantage Plan will suit your needs, you have more decisions to make. You may be given the choice of an HMO or PPO plan. It is important to know the differences between the HMO and PPO plans so you can pick the one that will be best for you.
Before choosing an HMO or PPO, it is important for you to evaluate your healthcare needs and preferences. You should consider your current health, any potential health concerns for your future, as well as your financial situation. For instance, do you have a particular doctor you visit regularly that you want to continue seeing? Are you willing to pay more for a greater amount of choice within your plan? Do you want the freedom to visit a specialist without a referral? If you answered “yes” to these questions, you may consider a PPO, or Preferred Provider Organization. A PPO may cost more than an HMO, but will allow you a greater choice of doctors and hospitals. You do not have to wait for a referral from your primary care physician before seeing a specialist. You are still required to visit a doctor within the PPO’s network, but you may choose to go “out of network” and pay a higher cost.
On the other hand, if you are comfortable choosing doctors and hospitals within a plan’s network, an HMO, or Health Maintenance Organization, may be the better choice for you. You will be asked to choose a primary care physician from the plan’s network of providers, who will act as a coordinator for your medical needs. In most situations, you will need to visit your primary care physician in order to get a referral to visit a specialist. It is important to understand the plan’s rules like getting prior approval when a certain service is needed. If you are contemplating an HMO plan that will fit your financial circumstances, but you are concerned about losing your favorite doctors, check the plan’s list of network providers. You may find that your doctors are indeed included in their network and you can continue seeing them. The cost of an HMO plan is usually lower than a PPO plan, but it is up to you to determine which plan will meet your needs.