Types of Medicare Advantage Plans HMO (Health Maintenance Organization) Plan: All of your health and wellness services (with the exception of emergency care, out-of-area urgent care, or out-of-area dialysis), will generally go through a primary care physician along with any hospitals and/or specialists that is in your plan’s network.
(If you see someone outside of this network, you may be responsible for the full cost of service/treatment.) PPO (Preferred Provider Organization) Plan: Although you will generally pay less if you go to a doctor, hospital, or other health care provider in your plan’s network, you have the option of going to an out-of-network provider. You do not need to choose a primary care physician, and, in most cases, you do not need a referral to see a specialist. PFFS (Private Fee-For-Service) Plans: You can generally go to any Medicare-approved doctor, hospital, or health care provider who accepts the plan’s payment terms and agrees to treat you. If your PFFS plan has a network, you can see any in-network provider or out-of-network provider who has agreed to treat plan members. Some PFFS Plans do NOT include prescription drug coverage. If not, you may need to purchase a Medicare Prescription Drug plan. SNP (Special Needs) Plan: This is for people who require specialized health care, such as those who live in a nursing home, have chronic health conditions, or who are on both Medicare and Medicaid. You will generally need to select a primary care physician who can refer you to a specialist in the network, if/when one is needed. Medicare Prescription Drug coverage is included in this plan. To find out more about Special Needs Plans visit Medicare.gov DSNP Plans Health plans for people who have both Medicare and Medicaid Dual plans offer extra benefits and features at no extra cost Dual plans go beyond either Medicaid or Original Medicare alone. You’ll still get to keep your Medicaid benefits and better yet, with a dual plan, you could get many extra benefits and features than Original Medicare at no extra cost. Extra Benefits may include Dental care for Preventative and Comprehensive care Eye Exams and Credits for additional eyewear Hearing Exams and credits for Hearing Aids Rides to Healthcare providers and to the Pharmacy Over-the-Counter benefits to use at a Pharmacy for nonprescription items As a bonus, people who are Dual Eligible usually have a Zero premium plan cost. Important: Medicare Advantage Plans usually contain Prescription Drug Coverage If you enroll into a Standalone Medicare Prescription Drug plan while you are enrolled in a Medicare Advantage Plan it will dis-enroll you from Your Medicare Advantage Plan and put in back into Original Medicare At MedicareinLasVegas, we are contracted with ALL the Medicare Advantage Plans Southern Nevada and many other states so we can help you sort out the Differences and then enroll YOU!.
