Just as winter starts to take hold, the frenzy to snag a bargain in Medicare coverage heats up with annual enrollment. Not only are there dozens of different Medicare Advantage plans available, but most of them also cover things Medicare doesn’t pay for like dental care, eyeglasses, hearing aids and health club benefits. With so many choices, you can see why there’s a frenzy of people trying to compare options before their chance to enroll ends on December 7.
One of the main attractions is getting help with prescription costs. Most Advantage plans cover prescription drugs, but the plans may cover different drugs and charge different co-payments. Check to see that your medication is covered before you apply.
Advantage plans differ from original Medicare in another way, too. They set up their own network of providers, so if you are already comfortable with your doctor, be sure to see if he or she is covered at in-network rates before you sign up for a plan. In case of emergency, you will have coverage to see doctors not affiliated with the network regardless of which plan you choose.
One thing you don’t have to check with Advantage plans is whether a pre-existing health problem will get your application declined. Advantage plans accept all health problems except end-stage renal disease. Certain areas also offer Special Needs Advantage plans that help with the care required for ESRD, but such plans are not available everywhere.
In addition to Special Needs plans, you can find several other types of Advantage plans:
HMO Advantage Plans
One version is the common Health Maintenance Organization or HMO Advantage plan. Most of these only allow you to go to in-network providers and hospitals, except in emergencies when there are no restrictions. These plans may also require you to obtain a referral from your primary care doctor before you can get coverage to see a specialist.
PPO Advantage Plans
Other Advantage plans are set up as Preferred Provider Organizations. With a PPO plan, you pay less to use doctors, hospitals, and other health care providers that are affiliated with the plan’s network, but you’ll have some coverage to see out-of-network providers.
PFFS Advantage Plans
In contrast, Private Fee-for-Service (PFFS) plans may not have any established provider network. In that case, any doctor can agree to treat you and the plan sets the rate it will cover. You may also be able to get a PFFS plan with a provider network. You will be able to see providers outside of the network who accept the plan’s terms, but you will probably have higher out-of-pocket costs if you do.
PFFS plans with provider networks do not require you to choose a primary care doctor, or get a referral to see a specialist. Not all PFFS plans cover prescription drugs, but you can add a Part D plan if you need help with prescriptions.
HMO POS Advantage Plans
HMO Point-of-Service Advantage plans are less common. They are basically HMO plans that provide some coverage if you see providers outside of the established network. But, you will have higher co-insurance or co-payments.
Jim McFadden has over 11 years of executive-level experience in the health insurance industry, is a youth baseball, softball and football coach, and has one of the worst fantasy football records in the world.