Do You Know About Medicare Advantage Health Plans?

Do You Know About Medicare Advantage Health Plans?

November 11, 2019 35 By akhilesh

There are two most common Medicare Advantage plans namely Health Maintenance Organizations (HMOs) & Preferred Provider Organizations (PPOs).

In the year 2019, there are a total of 2,734 Medicare Advantage plans in the market, out of which 1,754 are Health Maintenance Organizations & 862 are Preferred Provider Organizations.

Also Read: Top Rated Medicare Plans For You

Do you recognize these plans? If no, let us help you to know about HMOs & PPOs that will help you to choose a suitable one for you. Plus, you can also know about some other Medicare Advantage plans.


Difference Between HMO and PRO

Both HMOs & PPOs advantage plans are served by private insurance providers rather than the federal Medicare program. A major dissimilarity between the HMO plan and PPO plan is the extent of liberty to get outside a chain of healthcare companies to acquire care.

With the HMO plan, one should stay in the chain if he/she needs the insurance provider to provide coverage for health care costs. And with the PPO plan, an individual is free to get outside the chain but he/she would probably have to pay more.

Also Read: Best Medicare Advantage Plans 2020

People Who Should Own HMO

1) Those who reside in large cities

One should definitely own extra in-network options while they are having a high attentiveness of healthcare suppliers nearby them.

2) Those who will change their doctors

If your specialist is not in the chain, you will definitely have to shift to another.

3) Those who are searching for insurance companies to save money

HMOs had the minimum yearly out-of-pocket expenses (average $ 4,908) in the year 2018.

4) Those who need a leading doctor

There is nothing more amazing than having one doctor monitoring all your health requirements & also ensuring your complete health care.

With HMO advantage plans, one will have to be in a chain but the trade-off will be low policy costs. Normally, an insurance provider negotiates a low price with HMO chain providers.

Nearly all HMOs need members to appoint a primary care physician (PCP). Only through PCP, most of your treatments will start. If you need to visit a doctor, initially you will require a reference from your PCP.

Also Read: How to Compare Medicare Advantage Plan?

People Who Should Own a PPO

1) Those who do not reside nearby lots of providers

If you reside in any of those rural areas or in a place where your chain does not have many providers, then you can avail extra choices with the help of a PPO.

2) Those who have a favourite specialists

You are free to visit a specialist who is not in your chain.

3) Those who do not mind paying extra for extra choices

Regional PPOs render some of the high yearly out-of-pocket expenses ($ 6,519). Local PPOs are somewhat less costly ($ 5,908) but normally they have a small chain.

4) Those who need to visit a specialist

There is no need to get a reference to consult a specialist.

With PPO Advantage Plans, insurers negotiate low prices with a chain of insurance providers. 

However, if a person can pay more, he/she can also select out-of-network suppliers.

Also Read: Everything About Medicare F Plans

Other Medicare Advantage Health Plans

  • Private Fee-for-service (PFFS)
  • HMO Point-of-service (HMO-POS)
  • Special Needs Plans (SNPs)
  • Medical Savings Account (MSA)
  • Cost Plans

We can only help you to understand the different coverage options but it is your foremost duty to discover plans in your respective area & enroll in a suitable one!!