Coordinated Care Plans: HMO & PPO
Health Maintenance Plan (HMO)
The first type of Medicare Advantage plan is an HMO. This is a type of coordinated care plan in which you can choose a primary care doctor and hospital in your network. To see a network specialist, you will likely have to get a referral.
Medicare HMO plans often have the lowest monthly premiums of the three types of Medicare Advantage programs. This is because they are generally the most restrictive since they require a PCP.
Preferred Provider Organization (PPO)
These plans are also coordinated care plans but are generally more flexible than Medicare HMO plans. Under these plans, you typically don’t need a referral to see any doctor in your network. Furthermore, you can see providers outside of your network at a higher price.
Keep in mind that each plan is different. Make sure to check the Summary of Benefits to see what is covered.
Private Fee-for-Service Plans (PFFS)
These plans typically don’t have a network or are small if they do. With this plan, you can see any doctor who agrees to the plan’s terms and conditions. Furthermore, some plans cover Part D as well. These plans have been losing popularity but remain as an option.
Special Needs Plans (SNP)
These plans are only available to people who have chronic illnesses, are dual-eligible, or have been institutionalized. These plans have providers and drug formularies to better fit the needs of those who qualify and usually come in an HMO format.
Medical Savings Account Plans (MSA)
An MSA plan is essentially a savings account for your health care expenses as well as insurance benefits. Medicare will put a set amount of funds into your account each year, which you can spend on qualifying services. Keep in mind these are not available everywhere. It’s important to note that these plans do not cover Part D prescription drugs.
Medicare Advantage Enrollment
- Join a Medicare Advantage plan during your 7 month Initial Election Period for Medicare (3 months before to 3 months after your birthday month)
- Join or disenroll from Medicare Advantage during the Annual Election Period (October 15th – December 7th)
- Disenroll and rejoin Original Medicare in the Medicare Advantage Disenrollment Period (January 1st – February 14th)
- Join mid-year if you qualify for a Special Election Period. You may qualify if you:
- Move out of the MA service area: 63-day period to select a new plan in your area
- Involuntarily lose creditable coverage: 63-day period to select a new plan
- Gain or lose Medicaid eligibility: your SEP will last as long as you qualify for Medicaid
- Gain or lose a Part D low-income subsidy: your SEP will last as long as you qualify for the LIS
- Switch from employer coverage to an MA plan: 63-day period to select a plan
- Are a non-citizen who has just become lawfully present in the U.S.
- Just dropped Medigap for the first time: 12-month period to disenroll from a Part C plan and rejoin Original Medicare and/or Medigap
Which Medicare Advantage programs are available to me?
As experienced agents, we can help you determine which Medicare Advantage plans are available in your area. The plan must be in the service area of both Part A and B. From there, we can figure out what kind of coverage you need to help you find the best plan.
To start looking at Medicare Part C plans, call us at 212-484-9888. If you’re on mobile, just click the button to call: Call Now!