Medicare
Advantage (Part C)
Medicare Part
C, formerly known as "Medicare+Choice," is now known
as "Medicare Advantage". If you are entitled to Medicare
Part A and enrolled in Part B, you are eligible to switch to a
Medicare Advantage plan, provided you reside in the plan's service
area. Medicare Advantage provides the following options:
- Coordinated
Care Plans (the Balanced Budget Act of 1997's umbrella term
for managed care plans);
- HMO
plans, otherwise known as Health Maintenance Organization
plans, emphasize preventive care but without coverage for
providers or facilities outside the HMO network. They almost
always require a network primary care physician referral
to access a network specialist; they usually offer drug
benefits.
- POS
plans, otherwise known as Point of Service Plans, offer
a network of preferred providers, like HMO plans, but also
provide reduced benefits for providers or facilities outside
the HMO network. They typically require a referral from
a network primary care physician to access a network specialist;
they sometimes offer drug benefits.
- Regionally
Expanded Preferred Provider Organization (PPO) plans
are similar to POS plans but have broader geographic access
to network providers in a larger service area, and with
reduced benefits outside the PPO network. They do not typically
require a referral from a network primary care physician
to access network specialists. They may or may not offer
drug benefits.
- PSO
plans, otherwise known as Provider-Sponsored Organizations,
are similar to the POS plans but are usually organized with
physicians that practice in a regional or community hospital.
There may or may not be coverage for providers or facilities
outside the PSO network, depending upon the plan designs
offered. They may require a referral from a network primary
care physician to access network specialists. They typically
offer drug benefits.
- Medical
Savings Accounts set up in conjunction with private fee-for-service
plans providing:
- at
least the same benefit coverage levels as Medicare Parts
A and B; or
- high
deductible coverage.
Call 1-800-MEDICARE
or visit www.medicare.gov
to determine if your plan choices have improved in your area.
NEA Member Benefits believes that the more traditional coverage
offered by Medicare combined with a Medicare supplement insurance
plan is still the choice that gives you the most freedom.
It lets you choose your doctors and hospitals and helps you
control your out-of-pocket costs. It lets you remain
in control of the management of your care. While some
of the other options may appear a little cheaper up front,
they can limit your medical care choices and could hit your
pocketbook hard if you get seriously ill.
For more information, visit our new Consumer
Guide on Medicare and Medicare supplement insurance. |
