Medicare pays a fixed amount for your plan every month to the companies offering Medicare Advantage plans, on top of the premium you pay. These companies must follow rules set by Medicare, however, they can still differ greatly. Rules like the amount you pay out of pocket or how you obtain services can change each year and not every plan is available everywhere.
It’s important to review each option with CSG Medicare each year to ensure you get the plan that is right for you.
Where you live, your budget and your doctor preferences should all be taken into consideration before selecting a Medicare Advantage Plan.
Types of Medicare Plans
Health Maintenance Organization Plans (HMO)
A Health Maintenance Organization is a network of doctors and hospitals. With an HMO you choose a Primary Care physician from a list of doctors in your network for all of your care. When necessary, he or she will refer you to a specialist. If you go outside the network, except for emergency care, you must pay for your own care.
Preferred Provider Organization Plans (PPO)
A Preferred Provider Organization Plan offers more options than an HMO or POS. This plan is made up of a much larger network of doctors, so you are likely to have more freedom to choose your doctor. No doctor referrals are required to see a specialist. You are also allowed to go outside the network to any provider without having to pay the entire cost yourself, but you will usually pay a larger share of the cost.
Special Needs Plans (SNP)
Special Needs plans are available for people who are eligible for both Medicare and the Medicaid assistance program in Arizona, called AHCCCS. There are also special needs plans for those who live in nursing homes or another long-term care facility, or who have certain chronic diseases. CSG Medicare can walk you through the different Special Needs Plans if you qualify.
There is no one-size fits all Medicare Advantage Plan. It’s important to have an in-depth conversation with your agent to go over any concerns and find a plan that works for you.
Medicare MSA Plans
Medicare MSA plans cover all the services that a Medicare Advantage Plan covers but they combine a high deductible Medicare Advantage Plan (Part C) with a medical savings account. Medicare deposits money into the account which can be used to cover medical costs until your yearly deductible is reached. The plan then begins to cover costs. MSA plans do not include Medicare Part D, or prescription plans. That would need to be purchased separately. Dental, vision or long-term care benefits can be included in an MSA plan for an extra cost.
Health Maintenance Organization Point of Service Plan (HMOPOS)
A point of Service Plan is a type of HMO plan that allows you slightly more flexibility than a standard HMO plan. With this plan you can use doctors and hospitals outside of the network for some services, usually for a higher out of pocket cost. Some POS plans do not require a referral to see a specialist which enables you to choose your own doctor for that service.
Private Fee-for-Service Plans (PFFS)
A Private Fee for Service plan (PFFS) is not a network plan. You can see any doctor you wish but the doctor has the ultimate right not to treat you, even if they have treated you in the past. It’s important to check every time you make an appointment that the doctor is willing to accept payment from the insurance company offering the plan.
Medicare Annual Enrollment Period: October 15th – December 7th