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Medicare is a government-backed insurance program for people age 65 and older. However, certain people under the age of 65 can qualify for Medicare coverage. The Medicare program is divided into several parts, each covering expenses for different aspects of healthcare.
If you are enrolled in an Original Medicare plan, you will notice that you are often required to pay some out-of-pocket amounts when you receive health care. Medicare Supplement Insurance plans, also known as Medigap plans, exist to fill the cost gaps left behind by Original Medicare benefits.
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Medicare Advantage plans are Medicare health plans offered by private companies who have contracts with Medicare, which allow them to provide you with Medicare Part A (hospital care) and Part B (medical care) benefits. If you enroll in a Medicare Advantage plan, your benefits typically only apply when you are visiting health care professionals that are within your program’s network.
If you are expecting to enroll in a Medicare Advantage Plan, you must do so during an enrollment period. These are the current Medicare Advantage enrollment periods:
Medicare Advantage plans offer the same benefits as Original Medicare plans, but plans that offer additional benefits can also be purchased. Some of the benefits you could have in your plan include:
Medicare Advantage plans come in many different formats. The plan you choose will determine what healthcare expenses are covered. Therefore you should understand the different types of Medicare Advantage plans that are currently on the market.
Health Maintenance Organization (HMO) Plans normally only cover services rendered by healthcare providers within your program’s network. Although emergency care, out-of-area urgent care, and out-of-area dialysis are also covered under HMO plans. If you use healthcare services outside of the plan’s network of providers, you may be liable for the entire cost of those services. Most HMO plans also provide prescription drug coverage.
Preferred Provider Organization (PPO) plans prefer to cover the costs of healthcare services rendered within their network of providers, but they do allow beneficiaries to pursue out-of-network care if they choose. This means that a PPO will pay for your visits to any healthcare providers, but out-of-network services will usually cost more.
Private Fee-for-Service (PFFS) plans have set terms for how much you will pay healthcare providers for their services. Many PFFS plans form contracts with a network of providers who have agreed always to treat patients that are enrolled in that plan, regardless of if you’ve never seen them prior. It is possible to receive out-of-network care, but out-of-network healthcare providers must agree to your PFFS plan’s terms before your policy can cover those services.
Special Needs Plans (SNP) limit enrollment to people who have specific ailments or characteristics. Their programs are often tailored to exactly fit the needs of their beneficiaries. When enrolled in an SNP plan, you will normally need to seek care from healthcare providers within your plan’s network.
Grutz Financial can help you get started with Medicare Advantage, contact us now to learn more.
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