Medicare Advantage Plans come in several types, HMO, PPO and PFFS plans are some of the more common availiable but far and away the most common plan here in Texas is the HMO variety. Our state is blessed with several very large population centers likeDallas, Ft.Worth and Houston that these plans can build large doctor and hospital networks therefore providing members and potential members huge provider choices. Some of the best facilities in the nation like Baylor Hospital and Medical City in the DFW metroplex and now in HMO Advantage Plan networks making life easier for those on Medicare.
So, what is an HMO Medicare Advantage plan? Simple, they are plans provided by private insurance companies with a contract from Medicare to provide your health care benefits. The plans must provide at least the same benefits as Part A and B of Medicare and generally offer additional benefits like gym memberships and discounts, dental, vision and hearing benefits not normally offered by traditional Medicare.
Benefits of Lower Plan Premiums VS. Supplements
These plans all have pre set maximum out of pockets and most require co pays for things like doctor visits and hospital stays. Theses co pays make things easier on seniors as small co pays generally add up to a far lower amount as compared to the monthly premiums you would pay for a Medicare Supplement policy. Some Medicare Advantage HMO plans have a zero plan premium; however you will continue to be responsible for your normal Part B premium.
Some HMO Advantage plans also include your Part D Prescription Drug coverage so you can also benefit from not having an additional Part D Plan premium. It is also a good idea to check and see if your drugs fall within the plans formulary listing to enjoy maximum benefit. Once again, no Part D premium equates into potentially lower monthly premium cost.
Draw Backs of Doctor Networks
Now, with the good you have to take into account the bad. Medicare Advantage HMO plans require you to only use doctors and providers in the plan network unless its and emergency and sometimes those networks can get rather restrictive so check to be sure you can live with who is and is not in network. If you are someone that demands to preserve your choice of medical providers this plan probably won’t work for you, stick with a Medigap supplement plan. Another drawback is these plans are specific to certain counties and geographic locations. For example, one plan may operate in the four county DFW metroplex but that same plan wont be available in then very next county unlike supplements that are available everywhere.
Overall we feel that the MAPD concept is solid, provides Medicare users a great potentially lower cost option and provider networks have remained relatively strong for 2013, if you will do a little research on drug formulary list and provider networks you might find this is the plan for you. A fixed income is just that and we want you to keep as much of it as you can, for more information on these or any other Medicare Advantage plans just contact our office today.