The Five Types of Medicare Part CPosted by Medicare Made Clear
Medicare Part C, also known as Medicare Advantage, is a type of Medicare coverage provided by private insurance companies. Medicare Advantage plans combine help with hospital costs, doctor’s visits and other medical services, plus prescription drug coverage it you want it. If you are in the process of selecting a Medicare Part C plan, it is important to be familiar with the 5 types of plans and how they differ. In three kinds of Medicare Advantage plans- Health Maintenance Organization, Preferred Provider Organization and Special Needs plans – your care is “coordinated.” That means the plan may coordinate your coverage through a primary care physician who manages the care you receive from specialist and hospitals. The other two types of plans- Private Fee-For-Service and Medical Savings Account plans- do not use coordinated care.
Health Maintenance Organization (HMO) Plans
HMO Plans provide coverage for doctor’s office visits provided that the doctor “belongs” to your plan. HMO’s also cover hospital care at “in-network” hospitals. If you seek medical care outside of network (with the exception of emergency care, urgent care or renal dialysis) you will be charged for your medical expenses out-of-pocket. Some plans require that your primary care physician provide a referral if you need to see a specialist.
Preferred Provider Organization (PPO) Plans
PPO plans generally provide more flexibility when choosing a doctor and do not typically require a referral to see a specialist. And you can see doctors outside the network without having to pay the entire cost yourself. If you do visit a doctor or hospital outside the network, though, you’ll usually pay a larger share of the cost of your care.
Medicare Advantage Special Needs Plans
Special Needs Plans combine hospital care, outpatient care and coverage for doctor’s office visits in a single plan. Special needs plans are designed for special needs beneficiaries who need a considerable amount of medical care. Some of these plans even offer care managers or nurse practitioners who work as advocates for the patient to ensure they receive proper care.
Private Fee-For-Service (PFFS) Plans
Those who enroll in Private Fee-For Services Plans are generally able to see any Medicare-eligible provider who accepts their plans payment terms and conditions. Some of these plans do not include prescription drug coverage; those in need of drug coverage may need to buy Medicare Part D separately.
Medical Savings Account (MSA) Plans
Medical Savings Account Plans combine Medicare Parts A and B coverage; these plans are funded with a savings account. Once the deductable has been met, Medicare-covered expenses are paid for by the plan. Cost and coverage of these plans can vary greatly, which is why it is important to explore your options and be selective when enrolling in a Medicare Part C plan. Learn more about Medicare Part C coverage at http://www.medicaremadeclear.com.
The family of UnitedHealthcare® Medicare Solutions plans are insured or covered by an affiliate of UnitedHealthcare, a Medicare Advantage organization with a Medicare contract and Medicare-approved Part D Sponsor.
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