Medicare Advantage Plans are a type of Medicare health plan. These plans are offered by private insurance companies approved by Medicare and offer an alternative to Original Medicare.
Medicare Advantage plans Texas is designed to cover all or most healthcare costs, including medical services and prescription drugs. There are several different types of Medicare Advantage plans that provide different levels of benefits.
The three main categories of Medicare Advantage plans include:
Health Maintenance Organization (HMO) Plans
A health maintenance organization (HMO) is an option within the Medicare Advantage program.
With this plan, you must choose a primary care doctor who coordinates your care and treats you when you get sick. You can see any other doctor who accepts the plan, but the cost may be higher than if you visit a doctor who belongs to the plan.
The following are some of the benefits of HMOs:
- You pay less out-of-pocket for services covered by your plan than other Medicare Advantage plans.
- You may pay less for prescription drugs than with other types of Medicare Advantage plans. Your costs will vary depending on which drugs you take and how much they cost at different pharmacies in your area.
- You will only pay extra for coverage outside your service area or emergency room visits made outside your area if it’s medically necessary to get treatment immediately.
Private Fee-for-Service (PFFS) Plans
Private fee-for-service plans are the least restrictive of all Medicare Advantage plans. They allow you to visit any doctor or hospital in the country that accepts Medicare, including specialists, without having to get prior approval from your plan.
The only exception is if you need a type of treatment unavailable in your area, such as radiation therapy or chemotherapy treatment. If this is the case, you’ll have to get prior approval from your plan before receiving treatment.
Private fee-for-service plans also offer more coverage than basic Medicare benefits.
In addition to covering hospitalization and physician services, these plans also cover vision exams, hearing tests, and dental exams for seniors diagnosed with chronic conditions like diabetes or heart disease.
Private fee-for-service plans are more expensive than other private health insurance plans because they need provider networks to negotiate discounts on health care services for their members.
However, compared with Medicare Advantage HMOs and PPOs, private fee-for-service plans generally cost less each month because they don’t require members to pay deductibles or coinsurance when receiving medical care inside.
Special Needs Plans (SNPs)
SNPs are a Medicare Advantage plan created to help people with disabilities and chronic conditions.
These plans provide extra benefits and services not covered by Original Medicare. SNPs may include prescription drug coverage, vision, dental and hearing benefits, and other services. They can be an excellent choice for people who have specific health needs.
SNPs must meet certain requirements set out by the federal government to qualify for Medicare.
These requirements include:
- Providing extra benefits or services not covered under Original Medicare includes prescription drugs, vision care, and dental care.
- Offering at least some cost-sharing (copayment) – SNPs must offer some cost-sharing concerning services included in the SNP benefit package. However, they cannot charge cost sharing for items and services included in their benefits package that would otherwise be covered by Original Medicare (except coinsurance).
- Limiting member cost sharing based on income – The amount of member cost sharing is limited based on income (such that those with lower incomes pay less than those with higher incomes)
After reading this post, you should have a good idea about Medicare Advantage plans and what benefits you may have with this type of coverage. If you are still trying to figure out where to start, ask your primary care physician for advice.
Before you do that, check out the health insurance quotes online on ehealthinsurance.com to see how much each plan will cost you. Good luck finding the right Medicare Advantage plans for your needs!