With an HMO, you have a group of providers you must see to receive care, and you typically need referrals from your doctor to see specialists. This helps coordinate care because your primary care doctor will know about other medical professionals you are seeing.
With PPOs, Folden says, “You also have a network of doctors and hospitals. However, you can see providers outside the PPO network— it just sometimes costs more.”
While 72% of people enrolled in Medicare Advantage plans have a local HMO or PPO, a recent report from The Kaiser Family Foundation states that more than half of the people who joined a Medicare Advantage plan in the beginning of 2008 joined a PFFS plan. PFFS plans allow you to go to any doctor, as long as the doctor agrees to accept the plan’s terms of payment. “The premiums for a PFFS plan can look attractive, but each time you need health care, you have to verify that your doctor will accept payment for that service. It can change at any time,” says Michelle Holzer, Senior Health Insurance Assistance Program manager at the Maryland Department of Aging.
The Congressional Budget Office estimates PFFS plan enrollment will reach five million by 2017, accounting for one-third of all Medicare Advantage enrollment at that time. Before you join a PFFS plan make sure you find doctors, hospitals, and other providers willing to contact the plan for payment information and accept the plan’s payment terms.
More plan choices
If you have a medical condition like asthma or diabetes, a Special Needs plan might be appropriate for you. These plans typically offer extra benefits for specialized health needs and for people living in extended care.
“Special Needs plans frequently offer additional coverage for certain conditions at little or no cost. For example, all diabetic supplies are typically covered—not just a certain amount as would be covered with traditional Medicare,” Folden says.
The last option, a Medical Savings Account plan, has two parts: a high deductible health plan and a bank account. Medicare gives the plan an amount of money each year, and the plan deposits a portion into your account. You use the money in your account to pay your health care costs. Any money left in your account at the end of the year is added to your next deposit.
Making your selection
Only you or someone you trust can decide if a Medicare Advantage plan is the best option for you. “During Medicare’s open enrollment period senior centers and the Senior Health Insurance Assistance Program (SHIP) bring in extra personnel to help you pick your way through different plans,” Folden says.
To find your local SHIP office, contact your state’s Department of Aging or Insurance Administration.
Ask the right questions to find the right plan
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■What are the premiums and out-of-pocket costs?
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■Are there extra benefits (like dental care)?
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■What are the choices for doctors and hospitals?
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■Are prescription drugs covered by the plan?
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■Is there coverage when I travel?