Previously, Medicare Advantage Plans were available to all Medicare beneficiaries except those with ESRD or End Stage Renal Disease. If someone had an MA plan when he developed the disease, he could keep the coverage, though. Stil, these beneficiaries were not allowed to change their MA plan type, such as moving from an HMO plan to a PPO plan.
With a change in the rules, the CMS or Centers for Medicare & Medicaid Services now permits these beneficiaries more opportunities to change Medicare Advantage Plans. They are given the option to select from an HMO, a PPO, or a PFFS plan type.
HMO plans require beneficiaries to select a primary care provider within the network who will act as a gatekeeper on referrals to see specialists.
PPO plans do not have that requirement.
PPFS or Private Fee For Service plans also do not require referrals before you can consult specialists. With one of these plans, you can go to any Medicare-approved doctor or hospital as long as they accept the plans’ payment terms and agree to treat you. We make it easy to see what Medicare Advantage Plans are available in your area and you can get started right here on our website.
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.