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Published on: 19 Feb 2017 by saimi

MEDICARE ADVANTAGE PLANS: HMO VS PPO VS PFFS

HMO VS
PP
O
How can i choose THE
best OPTION FOR ME !

Choosing a Medicare Advantage plan can seem
like a very daunting process when you’re unfamiliar with the various types of
plans available. When it comes to choosing the best plan for yourself, you want
to ensure that you will be receiving the coverage that you require based on
your current, and future, needs. In the United States, Medicare Advantage plans
are provided through the use of private insurance companies, while still
adhering to the underlying requirements set forth by the government. Because
these plans are sold through many different private insurance companies, it can
be very difficult to decipher all of the information available.

Similar to traditional health insurance
plans, Medicare Advantage plans are available in different types of plans. HMO,
PPO, or PFFS are the most commonly available types of Advantage plans, but what
exactly do those letters mean?

 

Medicare Advantage Types: HMO, PPO,
PFFS

If you’re familiar with the traditional
types of health insurance plans, and how their coverage works, then these
letters may not seem so scary to you, but for many people, these terms can be
quite confusing.  

When it comes to the differences between
HMO, PPO, and PFFS plans, you first must know what the benefits and downsides
are to each of the different types. These different plan types outline the
rules for getting coverage for various medical services. They also determine
how much you the insurance company will cover in terms of doctors, hospital
visits, and specialists’ visits, versus how much you will owe out of pocket.

So while these plan types may seem
confusing right now, let’s take a look and see what each different type means.

 

A: HMO (Health Maintenance Organization)

 

When it comes to Medicare Advantage plans,
the largest benefit of going with an HMO plan is the fact that they are
generally less expensive than the other plan types. Paying less doesn’t come
without its disadvantages though. In order to see a specialist you must first
visit your primary car physician and receive a referral. This is different from
a PPO, since a PPO allows you to visit a specialist directly without the need
for a referral.

Along with needing a referral to see
specialists, HMO plans generally do not cover your medical expenses if a doctor
that isn’t within the policy’s network, unless it is an emergency situation,
performed them. Because of this, you should verify that your doctors are within
the network before deciding to switch to an HMO plan.

While it seems like there are a lot of
rules and regulations when it comes to ensuring you are covered within your HMO
policy, it’s these rules and regulations that allow these plans to be less
expensive than the others.

 B: PPO (PREFFERED PROVIDER
ORGANIZATION)

If you’re looking for something with a
little more flexibility compared to an HMO plan, then a PPO might be a better
option. Unlike an HMO, the PPO allows you to visit a specialist without the
need to first visit your primary care physician and receive a referral. In fact
you do not even need to choose a primary care physician at all, you can visit
any doctors you choose. You will still be covered even if you visit a doctor
outside of the network, but your coverage may be less than if you saw one that
was in-network.

There is definitely more flexibility when
it comes to choosing a PPO plan as opposed to an HMO, but with the added
flexibility comes added costs. PPO plans generally tend to have a higher
premium and higher out-of-pocket costs than HMO plans, so it’s always important
to be sure you know what sort of coverage you are looking for.

 

C: PFFS (Private Fee-For-Service)

Private Fee-For-Service plans, PFFS, offer
even more freedom and flexibility than both HMO and PPO plans, but unlike the
other plans, the insurance company, not Medicare, determines how much it will
pay the provider and how much the beneficiary will pay. Another added benefit
of the PFFS plan is that you have the ability to add a Medicare Part D plan if
you so choose.

Similarly to PPO plans, you do not need to
choose a primary care physician, nor do you have to obtain a referral in order
to see a specialist. You can visit any hospital, doctor, or medical provider
that is within the network, and has agreed to the terms of your PFFS plan.
Out-of-network doctors can also be seen, but it may be more expensive. It is
important, if you see an out-of-network doctor, to always verify before your
visit that they will accept the terms of your plan. Out-of-network doctors are
not required to accept a plan in the future just because they have accepted it
previously.

This should help clear up some of the
confusion surrounding the various types of Medicare Advantage plans available
to the public today. If you need more information, or have further questions
regarding this topic, please call us at 888-506-6820. 

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