Medicare Advantage
Medicare Advantage plans are a popular, low-cost alternative to Medigap coverage for your health insurance. These policies are offered by private insurance companies with a contract from Medicare. Advantage plans will usually have a low or $0 premium in addition to your regular Part B premium. To learn more about Medicare Advantage insurance options in the Burlington, NC and Mebane, NC areas.
This type of plan may include Part D drug coverage although health coverage only is also available.
There are many types of Medicare Advantage plans available.
MEDICARE HEALTH MAINTENANCE ORGANIZATION (HMO):
Health Maintenance Organization members are required to choose a primary care physician within the plan’s network. In order to see a specialist some HMOs may require a referral from your primary care doctor. The specialist must also be in the plan’s network. You must also use network providers for all services including hospitals, lab work, and durable medical equipment suppliers. HMO plans usually offer the lowest premiums and co-payments. This is a good choice if your doctors and health providers are a part of the plan network.
HMO POINT OF SERVICE (POS):
A Point of Service (POS) plan is a type of managed health care system that combines characteristics of the HMO and the PPO. Like an HMO, you pay only a minimal co-payment when you use a health care provider within your network. You also must choose a primary care physician. If you choose to go outside the network for health care, POS coverage functions similar to a PPO. The plan will specify which benefits are available under the POS option and how much the co-payment will be for out-of-network benefit.
A MEDICARE PREFERRED PROVIDER ORGANIZATION (PPO):
Preferred Provider plan members have more freedom of choice. A PPO also has a network of providers but you are free to use out-of-network providers if you wish. You will simply pay a slightly higher co-payment when using out-of-network doctors and health care providers. These plans offer local, regional or national coverage. A good choice for those who travel or simply wish to have greater flexibility.
PRIVATE FEE FOR SERVICE (PFFS):
Private Fee For Service plans do not have a network. You can use this plan with any doctor or provider who agrees to the terms and conditions of payment from the plan. These plans include nationwide coverage and are a good option for those who travel or live in a rural area. PFFS plans are only offered in select counties.
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