Here are 6 Types of MAPD Plans:

  • Health Maintenance Organization (HMO) plans:
    In most HMOs, you can only go to doctors in your network (except in an urgent or emergency situation).

  • Preferred Provider Organization (PPO) plans:
    In a PPO, you pay less if you use doctors in your network. You usually pay more if you go outside of your network.

  • Private Fee-for-Service (PFFS) plans:
    PFFS plans are similar to Original Medicare in that you can generally go to any doctor as long as they accept the plan’s payment terms. The plan determines how much it will pay and how much you must pay when you get care.

  • Special Needs Plans (SNPs):
    SNPs provide specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.

  • HMO Point-of-Service (HMOPOS) plans:
    HMO plans may allow you to get some services out-of-network for a higher copayment or coinsurance.

  • Medical Savings Account (MSA) plans:
    These plans combine a high-deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. MSA plans don’t offer Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan.

How do I choose a Medicare Advantage Plan?

It is of course important to compare the benefits between your current coverage and the Medicare Advantage Plan. Be sure that you understand the additional benefits and any benefits (or freedoms) that you may loose. In general, we usually remind people to look at the Cost, Coverage, Convenience, Company reputation, and Comments from other Members. In particular, be sure to look at the following:

  • Can you change your current doctor(s) or are they in the new plan's network?

  • If prescription drug coverage is provided, are your medications on the plan's formulary?

  • How much is the monthly premium?

  • How much will your coverage cost? Co-payments and co-insurance as explained in the plan's Summary of Benefits.

  • Are there any treatments that you need that are not covered by the Plan?

  • Can you work within the network restrictions (like paying extra when you visit a doctor who is out-of-network)?

Be sure to give us a call to find out what great products and carriers we have for you and your clients!


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