Medicare Advantage

Despite the fact that most Arizona seniors work hard to stretch every penny, many have just a little bit too much income to qualify for Medicaid.  Our ACCESSMed volunteers help these individuals understand and take advantage of their Medicare Advantage options.

In addition to being cost-effective, many Medicare Advantage plans coordinate care between your health care providers. They combine medical, Part D prescription drug coverage, and some of additional benefits including coverage for routine vision care, hearing aids, routine dental care, prescription drugs and fitness center memberships.

Medicare Advantage healthcare insurance plans are provided by private health insurance companies (rather than the federal government). There are four types of plans:

• Healthcare Maintenance Organizations (HMO’s)
• Preferred Provider Organizations (PPO’s)
• Private Fee-for-Service plans (PFFS)
• Medical Savings Accounts (MSA’s).

Medicare Advantage HMO’s

HMO’s are managed health care systems that work to decrease costs for healthcare consumers. They frequently work with businesses that want to offer economical health insurance to a number of employees.

Advantages

HMO’s generally provide economical coverage as an adjunct to Medicaid and also for privately insured patients. Some HMO policies have a zero monthly premium. Most have relatively low out-of-pocket costs for prescriptions.

Disadvantages

HMO’s require participants to stay within their network. If your doctor is not in their network (or leaves it), you have to find a new primary care provider. In addition, most require a co-payment for each visit. And, unapproved non-emergency in-network and all out of network specialist visits are generally uncovered. Patients who require highly specialized treatment may find that their treatment is not available in-network (and, as a result, may be unaffordable).

Medicare Advantage PPO’s

A PPO Medicare Advantage plan is generally more expensive versus an HMO plan but is also more flexible.

Advantages

A PPO Medicare Advantage plan provides more flexibility to see doctors both in and out of network. Patients are not required to have a primary care provider and they are free to see specialists without referrals.

Disadvantages

PPO plans are more expensive versus HMO plans.

Private Fee-for-Service

Some PFFS plans have provider networks. Others allow patients to receive care from any hospital or doctor that accepts the plan’s coverage. Most plans do not require a referral from a primary care doctor in order to see a specialist and some plans include prescription drug coverage.

Advantages

You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan’s payment terms and agrees to treat you.

Disadvantages

PFFS plans are generally more expensive than HMO and PPO plans. Out-of-network doctors, hospitals, and other providers may not be contracted with a PFFS plan and will not accept the plan’s payment terms.

Medical Savings Accounts

An MSA plan is provided by a private company that the federal government pays to administer Medicare benefits. Unlike other Medicare Advantage plans, MSA’s include 1) a high-deductible health plan for Medicare Part A and Medicare Part B coverage, and 2) a medical savings account funded by an annual tax-free deposit.

Money in the savings account can be used to pay for Medicare Part A and Medicare Part B expenses. And, when the MSA deductible is met, the plan pays for all additional Medicare-covered services.

Advantages

Medicare contributes tax free funds to an MSA bank account on an annual basis and the accounts can earn interest that is tax free. Withdrawals from the account are also tax free, so long as they are used for qualified medical costs.

Disadvantages

In order to take advantage of an MSA plan, the beneficiary must be in good health and have a high deductible limit.