Original Medicare comes with a few gaps in coverage. While Part A and Part B cover hospital and medical coverage, they have no coverage for routine dental, vision, and hearing exams nor dentures, eyeglasses/contact lenses, or hearing aids. Prescription drugs are also an important factor left out, particularly for this demographic.
Medicare Part C, called Medicare Advantage, offers a more comprehensive coverage package than Original Medicare. These plans are offered by private, Medicare-approved companies that Medicare compensates for handling your Part A and Part B coverage. Medicare Advantage plans have prescription drug coverage and many have dental, vision, and hearing coverage as well.
Medicare Advantage plans come in a few common forms. Whether your plan is from an HMO, PPO, PFFS, or SNP, you will have coverage for hospital and medical insurance. The type of plan can determine whether or not you need a primary care physician or referrals for specialists, as well as if you need to see providers within the plan’s network. For more information regarding a plan’s policies, speak with the benefits manager.
HMO
Health Management Organization (HMO) plans require the insured to have a primary care physician and require referrals to see specialists. Seeing physicians outside of the plan’s network will cost much more than providers in-network.
PPO
Preferred-Provider Organization (PPO) plans do not require you to have a primary care physician and do not require referrals to see specialists. Although you benefit from more flexibility in the providers you can see, premiums tend to be higher with PPOs.
PFFS
Private-Fee-for-Service (PFFS) plans operate differently from HMOs and PPOs. they may or may not have a network. These plans allow you to receive care from any physician that agrees to treat you and accepts the plan’s payment terms.
SNP
Medicare Chronic Condition Special Needs Plans are designed specifically for those who have certain chronic conditions. Membership is restricted to people who have a certain chronic condition. Each plan has a network of specialists that treat that condition.
To learn more about which Medicare Advantage Plan may be right for you, give Hitcho Insurance a call today.
