Coverage Options For Medicare Eligible Individuals

People with United Healthcare medicare supplement can obtain their medical care through original Medicare or the Medicare Advantage Program (Part C). Medicare Advantage Plans consist of HMO, PPO, and Private Fee for Service Plans and Special Needs Plans. Over 10 million individuals enrolled in Medicare Advantage Plans, the majority are enrolled in HMO’s (Health Maintenance Organizations) which have been available since the 80’s.

To help your parents (or you) make an informed decision, they need to understand the functions of these plans, and then decide which plan is right for them. The following is a brief description of each of the plan types.

Original Medicare

If an individual chooses to go with a traditional service Medicare fee, they can generally use any doctor or hospital that accepts Medicare plan anywhere. However, Medicare does have deductibles, copays and cost sharing requirements that can play havoc with budgets. To help pay these additional out of pocket expenses, many individuals purchase Medigap or Medicare supplement policies.

Medicare Advantage Plans (Part C)

If you opt to go with a Medicare Advantage Plan, you actually trade your traditional Medicare benefits for these plans. Many of the Medicare Advantage Plans are offered to eligible individuals at little or no cost other than continued payment of their Part B monthly premiums.

Medicare HMO’s (Health Maintenance Organizations)

These plans cover the same physician and hospital costs as traditional Medicare, but usually with lower out of pocket costs. HMO’s are attractive to Medicare-eligible individuals because they often provide extra benefits like eyeglasses, hearing aids, and dental benefits which are not covered by traditional Medicare.

Individuals considering a Medicare HMO should be aware that they can only receive medical services from providers who are part of the HMO’s network of contracted providers. The HMO usually requires that an individual joining their plan select a primary care physician from those who participate in their network. This primary care physician would then be responsible for all medical care including referrals to a specialist and admittance to a hospital. The HMO will not pay for unauthorized visits to specialists nor non-emergency care received outside the HMO’s service area or visits to non-network physicians.

 

 

Medicare PPO’s (Preferred Provider Organizations)

These plans are private healthcare plans like HMO’s. However, PPO’s and HMO’s do differ into two very important areas. Firstly, Medicare PPO’s do cover eligible medical care services obtained from doctors and hospitals outside the PPO network. And, secondly, Medicare PPO’s do not usually require that you obtain an authorization before seeking care from a specialist.