• Health Maintenance Organization (HMO) plans: 

  You generally must get your care and services from doctors, other health care providers, or hospitals in the plan’s network (except emergency care, out-of-area urgent care, or out-of-area dialysis) . If you have a primary care doctor or specialist that you would like to stay with, its best to check if they accept the HMO plan you're looking into before joining.

Does this come with Prescription Drug Coverage? Usually

Do I have to pick a primary care doctor? Yes

Do I need a referral to see a specialist? Yes unless it's a yearly screening. 

• HMO Point-of-Service (HMO-POS) plans:

 These are HMO plans that may allow you to get some services out-of-network for a higher co-payment or coinsurance. 

• Preferred Provider Organization (PPO) plans: PPO plans have their own network doctors, health care providers & hospitals. However, PPO plans offer the flexibility of seeing someone out of network for covered services but at a higher price.

Does this come with Prescription Drug Coverage? Usually

Do I have to pick a primary care doctor? No. You can go to any doctor, health care provider or hospital that accepts Medicare in the network. Using the doctors in the network will save you money. You can use out of network providers at a higher cost. 

Do I need a referral to see a specialist? No. 

 • Private Fee-for-Service (PFFS) plans: A PFFS plan allows you to see any Medicare Approved doctor, healthcare provider or hospital that accepts the PFFS plans payment terms and agrees to treat you. Some PFFS plans have networks and you are able to see the doctors in these networks who have already agreed to treat you. If you choose to go with a network, you are able to go out of this network to seek medical treatment from providers who will accept the plans term but you may pay more. 

Does this come with Prescription Drug Coverage? Sometimes. If the plan doesn't offer a drug plan you can join a Medicare prescription Drug Plan

Do I have to pick a primary care doctor? No

Do I need a referral to see a specialist? No 

 • Special Needs Plans (SNPs): SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.  SNP's is for individual(s) who have a specific disease or diseases. It provides services and benefits to these individuals with specific diseases, health care needs or limited incomes. 

Does this come with Prescription Drug Coverage? Yes.

Do I have to pick a primary care doctor? Yes. Keep in mind some SNP's require in network use and some don't. It depends on the plan.

Do I need a referral to see a specialist? Yes.

 • Medical Savings Account (MSA) Plans:  These plans combine a high deductible health plan with a bank account that the plan selects. The plan deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. MSA Plans don’t offer Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan. MSA plans may not be available in certain area's. Please contact us or visit Medicare.gov to check and more information.

Does this come with Prescription Drug Coverage? You will have to join a Medicare Prescription Drug plan.

What do I need to join a Medicare Advantage Plan?

• Medicare Part A & B
• Live In A Plan's Service Area
• Do not have End Stage Renal Disease

Can I Join & leave a Medicare Advantage Plan Whenever?

• You can join during your initial enrollment period 
•  If you have Part A coverage and you get Part B for the first time during the General Enrollment Period, you can also join a Medicare Advantage Plan at that time. 
• Between October 15–December 7, anyone with Medicare can join, switch, or drop a Medicare Advantage Plan. 
• If you're already on a Medicare Advantage Plan-- January 1–March 31 each year is the Medicare Advantage Open Enrollment. During this time, you can switch MA plans or go back to Medicare. Please note that you can only make one change during this period.

I keep seeing ad's on the TV about extra benefits with MA Plans? What are they talking about? 

Most Advantage plans offer more than Original Medicare like Vision, Dental, Hearing, and programs that promote wellness. Gym memberships are a good example that are offered by some plans. As time goes on we've been seeing plans add even more benefits like adult day care services, over the counter medications,  transportation to doctors appointments, and much more.

If I Join a Medicare Advantage Plan What Happens to my Medigap Policy?

You can't have and don't need a Medigap Policy with an MA plan.

I have End Stage Renal Disease, Can I Join A Medicare Advantage Plan? 

If you have ESRD you can only join a Medicare Advantage plan under certain circumstances. However, Starting 2021 people with ESRD will be able to join MA plans without these circumstances.

There are quite a few options:

• You may be able to join a Special Needs Program if one is available in your area.
•  If you have an employer or union health plan or other health coverage through a company that offers one or more Medicare Advantage Plan(s), you may be able to join one of that company’s Medicare Advantage Plans.  
• If you are currently in a Medicare Advantage Plan and the Plan discontinues or is no longer available in your area. You have a one time right to join another MA plan.
• If you're medically determined to no longer have ESRD, you can join an MA plan.

What do I pay for a Medicare Advantage Plan?

Please contact us.