Medicare Advantage Insurance

Health Insurance for Individuals over age 65

Medicare Advantage expands the healthcare options for Medicare beneficiaries. These options were created by the Balanced Budget Act of 1997 in order to better control the rapid growth in Medicare spending, as well as to provide Medicare beneficiaries more choices.

Previously, you could receive Medicare benefits through original Medicare or via a Medicare Managed Health Maintenance Organization (HMO). With Medicare Advantage Insurance (also called Medicare Part C), you can choose from five new ways in which to receive your Medicare benefits.

New Medicare Advantage Options

• Preferred Provider Organization (PPO): A PPO is a managed care plan formed by a group of doctors, hospitals, and other healthcare providers who contract with an insurance company. You do not have to choose a primary care physician. You can go outside of the network; however, you will pay higher deductibles and have higher copays if you choose to visit an out of network physician.
• Provider Sponsored Organization (PSO): This is another managed care plan with a network of providers. The providers administer the plan and take the financial risk. You choose a primary care physician and agree to use only plan providers. Most services will be provided by the healthcare network.
• Private Fee for Service Plans (PFFS): This is an insurance plan, rather than a managed care plan. The plan, not Medicare, sets the fee schedule for providers, but providers can bill up to 15% more. You can see any provider you choose as long as the provider agrees to the payment schedule. Medical necessity is determined by the plan. The plan does not need to have a quality assurance program.
• Religious Fraternal Benefit Society Plans: A managed care plan formed by a religious or fraternal organization. These plans may restrict enrollment to members of their organization.

Other, less common types of Medicare Advantage Plans:

• HMO Point of Service Plans: An HMO that may allow you to get some services out of network for a higher cost.
• Medical Savings Account (MSA): A plan that combines a high deductible health plan with a traditional bank account. Medicare makes deposits into the account, usually less than the deductible. You can then use this money to pay for healthcare services during the year.

One of the best resources on the internet for researching your options is The Senior Health Insurance Information Program (SHIIP). SHIIP is a free & unbiased counseling program provided by each states Department of Insurance.

Carriers | About Us | Privacy Policy | Contact Us | Health Insurance Glossary | Site MapCopyright © 2003 - 2012