Benefit of Medicare advantage plans

Medicare Advantage (MA) Plans 

MA plans are also known as Medicare Part C, Medicare+Choice or Health Maintenance Organizations (HMOs). There are several types of MA plans, and each of these plans replaces “traditional” Medicare benefits. MA plans provide Medicare-covered benefits to members through the plan and may offer extra benefits that Medicare does not cover, such as vision or dental services. Members may have to pay an additional monthly premium for the extra benefits. The plan may have special rules that its members need to follow. Plan members generally get their Medicare-covered health care through that plan. Some plans also include Medicare prescription drug coverage. Benefits may be different from those in “traditional” Medicare and, since each plan can vary, it is very important that people review the plan materials for details about copayment and coverage information.

Providers can verify Medicare eligibility for patients who have enrolled in an MA plan by calling the IVR system or by using the online inquiry system. Notification that the patient has joined a plan, the effective dates and the identification number of that specific plan will be released. 

CMS has published a plan directory that provides further information regarding an MA plan. The plan directory, listing all MA plans and the identification numbers, is on the CMS Web site at:

http://www.cms.gov/MCRAdvPartDEnrolData/MACPC/list.asp#TopOfPage

Questions that might be asked during patient screening include:

 Have you made any recent changes to your Medicare plan?

 Have you recently added or updated your Medicare Part D (prescription drug) portion of your Medicare benefits?

 Have you received a new Medicare health insurance card for this year?

It is important to remember that people who join an MA plan:

 Are still in the Medicare program.

 Still have Medicare rights and protections.

 Will have a member ID card issued by the MA plan that should be used in place of the “traditional” Medicare red, white and blue card.

 Will still get all their regular Medicare-covered services that are offered under Part A and Part B through the MA plan.

 May get additional benefits offered through the plan, including Medicare prescription drug coverage. Other extra benefits could include coverage for vision, hearing, or dental care and/or health and wellness programs. Extent or duration of coverage may vary.

What Does a Medicare Advantage Plan Cover?

Medicare Advantage Plan - Understanding Medicare Part C

Medicare HMO and PPO Coverage and Options

A Medicare Advantage Plan is offered by private health insurance companies that are approved by Medicare and have a contract to provide you with Medicare benefits.

What Does a Medicare Advantage Plan Cover?

If you join a Medicare Advantage Plan, the plan must provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) benefits, including emergency and urgent care. The only major benefit not covered by these plans is hospice care – this benefit is covered by Original Medicare even if you choose a Medicare Advantage Plan.

Many Medicare Advantage Plans offer extra coverage, such as vision, hearing, dental, and general checkups and other health and wellness programs. Most advantage plans include Medicare prescription drug coverage (Medicare Part D).

Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO). These plans may require that you choose a primary care physician (PCP), get a referral from your PCP to see a specialist, and use only doctors, hospitals, and other medical facilities and services that are part of that health plan’s provider network.

Some private health insurance companies offer a Medicare Advantage Plan known as a Private Fee-for-Service (PFFS) Plan that may allow you to see any doctor or use any Medicare-approved hospital. However, unlike Original Medicare, you may have a copayment for doctor visits and not all providers may be willing to treat you. However, in a PFFS Plan you do not have to choose a PCP and you do not need a referral to see a specialist.

review of aetna US heathcare - Medicare HMO plan

Aetna US Healthcare (Medicare HMO)

For more information regarding Aetna US Healthcare's Medicare services, consult the chart below.

Benefits	Golden Medicare Plan	Golden Choice Plan (out-of-network benefit)
Doctor and Hospital Choice	You must go to network doctors, specialists, and hospitals. You need a referral to go to network hospitals and certain doctors, including specialists forcertain services.	You do not need a referral to go to network doctors, specialists and hospitals. You can go to doctors, specialists, and hospitals in orout of the network. Higher costs apply for out-of-network services.
Monthly Premium	$0-$25	$95-$130
Inpatient Hospital Care	$100-$150/day for days 1-5, $0 days 6-90	$350 for each Medicare-covered stay in a network hospital, no copayment for additional days in a network hospital, covered for unlimited days each benefit period
Skilled Nursing Facility	$20-$25/day for days 1-100 for Medicare-covered stay	No copayment, covered for 100 days each benefit period
Home Health Care	$20 for Medicare-covered visits	No copayment
Doctor Office Visits	$10-$30 for each primary care doctor office visit; $15-$35 for each specialist visit	$10-$20 for each primary care doctor office visit, $20 for each specialist visit
Prescription Drugs	You pay 100% for most prescription drugs; some plans offer $10 for each prescription or refill of generic drugs up to a 30-day supply and $20 for mail order generic drugs up to a 90-day supply	For each prescription or refill, $15 for generic drugs up to a 30-day supply, $30 for mail order generic drugs up to a 90-day supply
Routine Physical Exam	$10-$20 for each exam, covered for 1 exam every year	$20 for each exam, covered for 1 exam every year

For more information regarding Aetna US Healthcare, visit the company website at www.Aetna.com.

How medicare advantage and drug plan are rated

Health plans are rated on how well they perform in five different categories:

·       Staying Healthy: Screenings, Tests and Vaccines (13 measures)

§  Members  have at least one primary care doctor visit in the last year

§  The percentage of members who have had breast cancer screening in the last year

§  The percentage of members who have had colorectal cancer screening in the last year

§  The percentage of members with heart disease who have had cholesterol screening in the last year

§  The percentage of members with diabetes who have had cholesterol screening in the last year

§  The percentage of members who have had glaucoma testing in the last year

§  The percentage of members who have had osteoporosis testing in the last year

§  The percentage of members who have had an annual flu vaccine

§  The percentage of members who have had an annual Pneumonia vaccine

§  The percentage of members taking long-term medications who have been monitored  

§  The percentage of members who were advised by their physician to start, increase, or maintain physical activity

§  The percentage of members who improved or maintained their physical health after two years

§  The percentage of members who improved or maintained their mental health after two years

·       Managing Chronic (Long-Lasting) Conditions (10 measures)

§  Osteoporosis management

§  Eye exam to check for damage from diabetes

§  Kidney disease monitoring for members with diabetes

§  Percentage of plan members with diabetes whose blood sugar is under control

§  Percentage of plan members with diabetes whose cholesterol is under control

§  Controlling blood pressure

§  Rheumatoid arthritis management

§  Testing to confirm chronic obstructive pulmonary disease

§  Improving bladder control

§  Reducing the risk of falling

·       Ratings of Health Plan Responsiveness and Care (6 measures)

§  Doctors who communicate well

§  Getting appointments and care quickly

§  Ease of getting needed care and seeing specialists

§  Overall rating of health care quality

§  Members’ overall rating of health plan

§  Customer service

·       Health Plan Member Complaints and Appeals (4 measures)

§  Complaints about the health plan (number of complaints for every 1,000 members)

§  Health plan timely decisions about appeals

§  Fairness of health plan’s denials to member appeals, based on an independent reviewer

§  Beneficiary access problems Medicare found during an audit of the plan

·       Health Plan Telephone Customer Service (3 measures)

§  Time on hold when customer calls health plan (minutes; seconds)

§  Accuracy of Information members get when they call the health plan

§  Availability of TTY/TDD services and foreign language interpretation when Members call the health plan

Drug plans are rated on how well they perform in four different categories:

·       Drug Plan Customer Service (7 measures)

§  Time on hold when customer calls drug plan (minutes: seconds)

§  Time on hold when pharmacist calls drug plan (minutes: seconds)

§  Accuracy of information members get when they call the drug plan

§  Drug plan provides pharmacist with up-to-date and complete enrollment information about plan members

§  Drug plan’s timeliness in giving a decision for members who make an appeal.

§  Fairness of drug plan’s denials to a member’s appeal, based on an independent reviewer

§  Availability of TTY/TDD services and foreign language interpretation when members call the drug plan

·       Member Complaints and Staying with Drug Plan (5 measures)

§  Beneficiary access problems Medicare found during an audit of the plan

§  Complaints by members about joining and leaving the drug plan (rate per 1,000 members)

§  All other complaints about the drug plan (per 1,000 members)

·       Member Experience with Drug Plan (3 measures)

§  Drug plan provides information or help when members need it

§  Members’ overall rating of drug plan

§  Members’ ability to get prescriptions filled easily when using the drug plan

·       Drug pricing and Patient Safety (4 measures)

§  Completeness of the drug plan’s information on members who need extra help

§  Drug plan provides accurate price information for Medicare’s Plan Finder web site and keeps drug prices stable during the year

§  Drug plan’s members 65 and older who received prescriptions for certain drugs with a high risk of side effects, when safer drug choices may be possible

§  Using the appropriate blood pressure medication recommended for people with diabetes

cost of Mediare advantage plan

What Does a Medicare Advantage Plan Cost?

Each month, Medicare pays your advantage plan a fixed amount of money to provide your care. The advantage plan is then responsible for paying your doctor, hospital, and other providers of care.

Although your advantage plan must follow Medicare’s rules, it can charge you a premium and additional out-of-pocket expenses, such as a copayment for a doctor visit, coinsurance for durable medical equipment (such as a wheelchair), and an annual deductible for prescription medications.
You also are responsible for your Medicare Part B monthly premium, which is taken out of your social security check.

For example: George C. lives in Massachusetts and has a Medicare Advantage Plan through Fallon Community Health, one of the highest-rated health plans in the country. He has an HMO plan with drug coverage. His monthly premium cost for the plan is $208.40 (the Medicare Part B premium of $96.40 plus $112 charged by Fallon). Also, his out-of-pocket expenses include a $15 copay for each PCP visit, $20 for each specialist visit, 10% coinsurance for durable medical equipment, and an annual deductible of $310 for prescription medications.

Joining Medicare advantage plan - how

How Do I Join a Medicare Advantage Plan?

Generally, you can join a Medicare Advantage Plan if you have Medicare Part A and Part B and you live in an area where there is an advantage plan that accepts new members. Some plans only cover certain counties within a state and you must live in one of those counties where the plan is offered.

Some Medicare Advantage Plans hold local seminars to introduce their plans and you can get and complete a paper application at that time. You also can enroll by calling the plan, visiting the plan’s website, or on www.medicare.gov. The Medicare site also lets you compare plans in your area. You also can join by calling Medicare at 800-633-4227.

If you are switching to a different advantage plan, all you have to do is join the new plan and you will automatically be disenrolled from your old plan. You will not have any lapse in your coverage.
Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning three months before the month you turn 65 and ends three months after the month you turned 65.

For example, if you turn 65 on April 28th, your eligibility period starts on January 1st and ends on July 30th.
If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after your 25th month of disability.
You also can switch or drop your advantage during an enrollment period between November 15 and December 31 of each year.

Things you must know about Medicare advantage plan

What Else Do I Need to Know About a Medicare Advantage Plan?

It’s important that you understand the differences between Original Medicare and Medicare Advantage Plans. Some things to remember about advantage plans are:

•    You must follow the rules! For example, if you are in an advantage plan HMO, you must choose a PCP and only use network services.
•    You can join an advantage plan even if you have one or more pre-existing conditions. There is no waiting period.
•    If your advantage plan decides to no longer participate in Medicare, you can join another plan or return to Original Medicare.
•    If your advantage plan does not include prescription drug coverage, you can join a Medicare Part D plan in your state. However, according to Medicare: “If you are in a Medicare Advantage Plan that includes prescription drug coverage and you join a Medicare Prescription Drug Plan, you will be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.”
•    As long as you are enrolled in a Medicare advantage Plan, you do not need to buy a Medicare Supplement Insurance policy (Medigap). In fact, it is illegal for anyone to sell you a Medigap policy if you are in an advantage plan. The benefits offered by a Medigap policy are covered by your advantage plan and the supplement does not pay for your plan's deductibles, copayments, or coinsurance.

Medicare Advantage Plans and Health Reform

Medicare Advantage plans cost the federal government more than traditional Medicare. Beginning in 2012, Medicare will start to decrease the subsidies to these plans.
If you are enrolled in a Medicare Advantage plan, you may have to pay a higher premium or deal with reduced benefits. However, these plans cannot reduce any of the benefits that you would normally receive from traditional Medicare.

Medicare update on advantage plan and drug benefit

PROPOSED CHANGES TO THE MEDICARE ADVANTAGE AND THE MEDICARE PRESCRIPTION DRUG BENEFIT

 

PROGRAMS FOR CONTRACT YEAR 2012 AND DEMONSTRATION ON QUALITY BONUS PAYMENTS

Background

This proposed rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care Education and Reconciliation Act of 2010 (the Affordable Care Act) that are related to the Medicare Advantage (MA, or Part C) and Prescription Drug Benefit (Part D) Programs.  This proposed rule also sets forth programmatic and operational changes to the Medicare Advantage and Prescription Drug Benefit programs for contract year 2012 based on our continued experience with the administration of the Parts C and D programs.  We are proposing to publish the final rule before the beginning of the 2012 contract year, in time to prepare plans for 2012 bids.  Most provisions will be in effect 60 days after the publication of the final rule (see Tables 1 and 2 in the proposed rule for provisions with different effective dates).

In addition to the proposed rule, CMS is posting the 2011 Medicare Plan Star Ratings and announcing a Demonstration Project to accelerate quality bonus payments for four and five-star plans and add quality bonus payments for three and three ½ star plans.  The Demonstration Project builds on the quality-related bonus payments authorized in the Affordable Care Act by providing stronger incentives for plans to improve their performance thereby accelerating quality improvements during the three-year period of the demonstration. 

PROPOSED RULE

The proposed rule addresses the following:

·       Implementing provisions of the Affordable Care Act;

·       Clarifying various program participation requirements;

·       Strengthening beneficiary protections;

·       Strengthening Medicare’s ability to distinguish stronger health plans for participation in Medicare Parts C and D and to remove consistently poor performers; and

·       Implementing other clarifications and technical changes.

 

Medicare advantage and drug plan rating and review

2011 Medicare Plan Star Ratings

·       The Medicare Plan Finder web site provides tools to help beneficiaries compare Medicare health plans with or without prescription drug plans, and stand-alone prescription drug plans.  It includes Medicare Plan Star Ratings, which measure plan quality and performance.  This information will help beneficiaries choose a plan that meets their specific needs. 

·       Plans receive a star rating for each category and every individual measure within the category. A contract can get ratings between one to five stars:

*                    means poor performance

* *               means below average performance

* * *          means average performance
* * * *      means above average performance

* * * * *  means excellent performance

·       Additionally, health and drug plans receive an “Overall Plan Rating” that summarizes all category measures into a single rating: one for health plans, one for health plans with prescription drug coverage, and one for stand-alone prescription drug plans. This overall rating includes half-stars to provide more differentiation between contracts. 

Distribution of Overall Plan Ratings for MA-PD Contracts (2011) * **

Overall Score	Contract Count	%	MA-PD % Weighted By Enrollment
5 stars	3	0.5	1.0
4 stars	74	13.2	23.2
3 stars	271	48.4	60.4
2 stars	48	8.6	7.2
Not enough data to calculate overall rating	104	18.6	3.6
Plan too new to be measured	60	10.7	4.5
Total	560	100	100

  *   Half-star ratings are rounded down for these distributions

        **  These ratings summarize all Part C and Part D measures combined.

            This star rating distribution is the same as the star rating  distribution for purposes of the quality bonus determination  under the demonstration. 

Distribution of Overall Plan Ratings for PDP Contracts (2011)

(These scores are the same as Part D summary rating for PDP contracts)

* Half-star ratings are rounded down for these distributions

For plan year 2011, plans that have received fewer than three stars for three consecutive years, will have a “low performer” icon affixed to the plan name on the Medicare Plan Finder.  Beneficiaries who are considering a plan that has received the low performer icon should study in more detail all specific quality information provided on www.Medicare.gov for the plan they are considering.

Aetna US Healthcare (Medicare HMO)

Aetna US Healthcare (Medicare HMO)

Aetna has been one of the leading providers of quality health insurance in the United States for the last 150 years. There dedication to providing families with safe, cost effective health insurance plans places this provider amongst the crème de la crème of customer service firms. They maintain their position as a leader in the health industry through the practice of these core values:

    * Integrity.
    * Quality service and value.
    * Excellence and accountability.
    * Employee engagement.

Aetna US Healthcare provides effective service and easy to understand information regarding the benefits involved with choosing one of their many, high quality health insurance plans. This is a smart choice when it comes to health insurance.


Available in certain areas of California, New Jersey, New York and Pennsylvania, the Golden Medicare is a managed care plan like an HMO. This plan doesn’t allow for as much flexibility as a fee-for-service plan, only offering coverage within an established network of doctors, specialists and hospitals. A PCP, or primary care physician, is selected. This PCP will have access to all your medical history and manage your care. To be eligible for Aetna US Healthcare's Golden Medicare plan you must, first and foremost, live in the designated area: you need to qualify for Medicare Part A, and enrolled in Medicare Part B. Aetna US Healthcare's Golden Choice plan allows for a little more flexibility. This is a Medicare + Choice plan with out of the network benefits. These benefits include: visit any licensed out-of-network physician, and pay applicable deductible and coinsurance, visit any in-network physician and pay applicable specialist copay, or visit your PCP and pay the applicable PCP copay.

Medicare HMO - cigna healthcare review and coverage

Cigna Health care (Medicare HMO)

Cigna Healthcare offers you customized Healthcare plans that are perfectly molded to the specific needs of your company, whilst at the same time allowing the flexibility that is needed in this constantly changing industry. Cigna Healthcare provides a wide variety of healthcare options ranging from HMO plans and flex care plans, to open access plans, indemnity plans and preferred provider plans. A few examples of these plans follow below:

PPO Plus ( Preferred Provider Plan )

Key Features:

    * Access to a wide range of physicians, specialists and hospitals across the company, all providing quality care and service.
    * 450,000 available physicians to choose from.
    * Nationwide emergency care coverage. (24-hour service)
    * Customized cost-sharing options readily available - copayments, deductibles and coinsurance.

Advantages:

    * No primary care physicians required.
    * Simple "away-from-home" care, through a toll free number, offering nearby participating physicians.
    * 24-hour health information line offering all the answers to your health insurance related queries.
    * A large network of quality physicians across the country.

Indemnity Basic and Extensive Medical Coverage ( Indemnity Plan )

Key Features:

    * Unlimited choice of providers for members.
    * Hospital Savings Program offers discounts for hospitalization.
    * Lifesource Transplant service for transplant services that are specialized.
    * Discounts towards health products and services made available through Healthy Rewards program.

Advantages:

    * Available services in all 50 states.
    * Can be grouped with numerous other options to allow for a "complete benefits program."

For more information regarding Cigna Healthcare and their many services and plans, visit their website at www.Cigna.com.

blue shield HMO information basic benefit details

Blue Shield Insurance (Medicare HMO)

The Blue Cross Blue Shield Association is a consumer health advocate with the public interest as its driving force. Their Blue plans have been providing families with the highest quality of health insurance services for 70 years. The Blue Shield Association only offers its members the highest quality, most innovative & customer focused, health insurance plans available. As we step further into the 21st century, medical breakthroughs are going to require changes in policies and coverage, and Blue Cross Blue Shield will be there for its customers, every step of the way.

Blue Shield offers one group of Medicare plans, the Blue Shield 65 Plus Medicare + Choice HMO plans. These Medicare plans have no deductibles. They cover all patient care provided by the original Medicare plan, but also cover additional services such as prescription drugs, vision care and physical examinations. Similar to Aetna’s prerequisites, in order to qualify for the Blue Shield 65 Plus Medicare + Choice HMO plans, you must be a Medicare beneficiary who is entitled to both Part A and Part B, and you must live within the designated area.




For more information regarding the Blue Shield 65 Plus Medicare + Choice HMO plans, consult the chart below.

Benefits	Blue Shield 65 Plus
Doctor and Hospital Choice	You must go to network doctors, specialists and hospitals. You need a referral to go to network hospitals and certain doctors, including specialists, for certain services.
Monthly Premium	$0
Inpatient Hospital Care	$50/day for days 1-40 and $0/day for days 41-90 for a Medicare-covered stay in a network hospital, covered for unlimited days each benefit period
Skilled Nursing Facility	$0/day for days 1-20 and $50/day for days 21-100, covered for 100 days each benefit period
Home Health Care	No copayment for: Medicare-covered home health visits and respite care
Doctor Office Visits	$10 for each primary care doctor office visit, $20 for each specialist visit
Prescription Drugs	For each prescription or refill, $10 for formulary generic drugs up to a 30-day supply; $25 for formulary brand drugs up to a 30-day supply; $20 for mail order formulary generic drugs up to a 90-day supply; $50 for mail order formulary drugs up to a 90-day supply
Routine Physical Exams	After a $5/$10 copay, pays 100% of expenses

For more information regarding Blue Shield, visit their website at www.BlueShield.com.

review of blue cross Medicare HMO details.

Blue Cross insurance (Medicare HMO)

The Blue Cross is a consumer health advocate with the public interest as its driving force. Their plans have been providing families with the highest quality of health insurance services for 70 years. The Blue Cross Blue Shield Association only offers its members the highest quality, most innovative & customer focused, health insurance plans available. As we step further into the 21st century, medical breakthroughs are going to require changes in policies and coverage, and Blue Cross Blue Shield will be there for its customers, every step of the way.

Blue Cross offers a single Medicare + Choice HMO plan, the Blue Cross Senior Secure plan. The benefits of this plan include low or no, monthly premiums, low copayments for doctor office visits, and coverage for vision, dental and routine podiatry care. This plan, however, is only available in select geographic locals.




For more information regarding the many available plans to choose from, consult the chart below.

Benefits	Blue Cross Senior Secure
Doctor and Hospital Choice	You must go to network doctors, specialists and hospitals
Monthly Premium	$0-$30
Inpatient Hospital Care	Member pays $160/$165 per day until the $2,100 annual out-of-pocket maximum has been reached
Skilled Nursing Facility	100% up to 100 days per benefit period
Doctor Office Visits	$5/$10 Primary Care; $10/$15 Specialist
Prescription Drugs (on Senior Secure Approved List)	For each prescription or refill, $8 for generic drugs up to a 30-day supply; $20 for mail order generic drugs up to a 90-day supply
Routine Physical Exams	After a $5/$10 copay, pays 100% of expenses

For more information regarding Blue Cross, visit the company website at www.BlueCross.com.

what is ppo and pos with example

PPO (preferred provider organization)

This plan is somewhat similar to indemnity plans. It offers you the freedom to access the doctor of your choice. (Costs are lowered within a given network however) If you travel outside the network, you will be forced to pay a copayment based on higher charges. In addition, you might also be forced to pay the difference between the fee and the amount covered by your specific health insurance plan.

POS (point-of-service)

A POS health insurance plan is one of the more expensive insurance plans to choose from. Within a POS health insurance plan, you have a primary care physician (PCP) who has the ability to refer you to other providers within the given health insurance plan. If your PCP refers you to a physician outside of the network, all or most of the bill will be covered by your POS plan. Within the POS plan you also have the option to refer yourself outside of the network. However, in such instances, you would have to pay coinsurance.


health insurance providers

Insurance providers offer people the security and comfort that they both deserve and sorely need in such an unsure world that we are now living in. The insurance providers generally offer more than one type of plan so that consumers and employers can find the best plan to fit their unique circumstances. Although most providers do offer healthcare, in most cases they are not strictly limited to it, and, in fact, offer a wide variety of programs and services to satisfy everyone's needs.

A few of these providers include:
•    Aetna US Healthcare
•    Blue Cross Insurance
•    Blue Shield
•    Cigna Healthcare
•    United Healthcare

Medicare 4 type of plan and comparison

Medicare Health care

Today, life expectancies are considerably greater than they have ever been before. A reasonable explanation for this longer lifespan is directly related to the progress in medicine. More than ever, families are finding the health care plans that work best for them, and getting the health care and services that they so rightly deserve.

There are 4 major categories of health care. These categories are:

•    Indemnity (fee-for-service) plans.

•    PPO (Preferred Provider Organization).

•    POS (Point-of-Service Plan).

•    HMO (Health Maintenance Organization). 

For a general comparison of these four categories, consult the table below.

Indemnity                              PPO                                   POS                         HMO

More Expensive <--------------------------------------------------------->Less Expensive

More Freedom of Choice<----------------------------------->Limited Options for Care

HMO - doctors inside the HMO network will be covered. All costs outside the HMO network need to be handled independently. HMO policy holders choose a Primary Care Physician (PCP) who will be responsible for coordinating their healthcare. 

POS - Somewhat similar to an HMO plan, POS policyholders select a PCP to coordinate their healthcare. Your PCP can make referrals outside of the policy network and your POS plan will continue to finance the majority, if not all of your costs. 

PPO - PPO policies allow for a far greater amount of freedom of choice. If you stay within your PPO network, your charges will be significantly lowered. You can choose to go outside the network without a referral and still get partial coverage, however you will be responsible for the bulk of the charges. 

Indemnity - When it comes to Indemnity policies, there isn't any kind of network, freeing members up to visit the healthcare facility/personel of your choice. A claim will be submitted to your insurance company and they will pay for incurred services that are covered by your plan. This insurance is the most expensive type.

what is indeminity plan and what should consider

Indemnity plans

The benefit of choosing an indemnity plan as your type of health insurance plan, otherwise known as a fee-for-service plan, is that it doesn't bog you down into a single network of physicians. Indemnity plan holders are given the freedom to choose/visit the doctor of their choice. In the case of indemnity plans, the remaining bill is then submitted to the insurance provider who pays the covered expenses. (Typically this consists of approx. 80% of the bill, leaving indemnity plan holders to pay the other 20%) This type of health insurance plan generally has what is called an "out-of-pocket" maximum. After this kicks in, your health plan provider pays for all covered benefits.

What you should know prior to purchase?

Although the most expensive type of health insurance policy, indemnity, or Fee-for-service insurance gives you the most flexibility and freedom to go to the doctor / medical facility / health care specialist of your choice. After receiving treatment, you must submit a claim to your insurance company (doctor or facility generally handles submissions) in order to receive reimbursement. Indemnity plans are customized so as to fit the needs of each unique policyholder, and as such, you will only be reimbursed for healthcare expenditures specified by your policy.

How Do Medicare Advantage Plans Work?

2019 Medicare Advantage Plans .

Medicare Advantage plans are a lot like the health insurance you may have had before becoming eligible for Medicare.

Our Medicare Advantage plans cover everything Original Medicare does and more. You'll get access to top doctors and hospitals at a more affordable cost, whether you're at home or away. These extra benefits keep you healthy from head to toe and cover hospital expenses beyond your Medicare limit.

Extra dental, vision and hearing coverage options available Protect yourself with a supplemental buy-up that offers more than preventive coverage.

Travel coverage
Stay covered, no matter where you go.

SilverSneakers® fitness program
Work out even while traveling with more than 15,000 fitness locations nationwide.

2019 Medicare Advantage-Light Plans

These plans have lower monthly payments than our balanced and extended plans. But you'll have some higher out-of-pocket costs.

All these plans have more benefits than Original Medicare. Compare them here and find the one best for you.

Light Plans(5 plans)

Features:
Part D prescription coverage
$15 primary care physician office visits
Online visits
Extra travel coverage
SilverSneakers

Medical deductible
You pay $290 in network.
You pay $200 for point of service.

Pharmacy deductible
Most generic drugs: $0
All other drugs: $405

Out-of-pocket maximum
You pay $4,500 in network.

2019 Medicare Advantage-Balanced Plans

These plans offer a good balance between cost and coverage. You get the same benefits you'd get with Original Medicare, plus Part D prescription coverage and dental and vision care.

So the choice comes down to network size and how much you want to pay out of pocket.

With this plan, you'll see doctors in a local network. You'll have low monthly payments and no copay when you visit your doctor.

Balanced plans(5 plans)

Features:
Part D prescription coverage
$0 primary care physician office visits
Online visits
SilverSneakers®
Medical deductible
You pay $0.

Pharmacy deductible
You pay $0.

Out-of-pocket maximum
You pay $3,800.

2019 Medicare Advantage-Extended Plans
If you use your health care a lot, get the protection of an extended plan. You’ll trade high monthly payments for low costs when you go to the doctor.

These plans cover more than Original Medicare, including prescription drugs and some dental and vision care.

Extended Plans(2 plans)

This plan offers all-in-one coverage. You’ll have the freedom to choose from the largest network of doctors and hospitals in Michigan. You don't need a referral.

Features:
Part D prescription coverage
$5 primary care physician office visits
More doctor choice
Online visits
Extra travel coverage
SilverSneakers®
Medical deductible
There is no deductible for in-network care. Out-of-network services have a $180. deductible.

Pharmacy deductible
You pay $0.

Out-of-pocket maximum
You pay $3,900 in network.







Can I get my health care from any doctor or hospital?

Private Fee for Service (PFFS) Plan : In some cases, yes. You can go to any Medicare-approved doctor or hospital that accepts the plan’s payment terms and agrees to treat you. Not all providers will. If you join a PFFS Plan that has a network, you will usually pay more to see out-of-network providers.

Medical Saving Account (MSA) Plan : Yes. Some plans may have preferred doctors and hospitals you could go to for a lower cost.

Special Needs Plan (SNP) : You generally must get your care and services from doctors or hospitals in the plan’s  network (except emergency care, out-of-area urgent care, or out-of-area dialysis). Plans typically have specialists for the diseases or conditions that affect their members.



Are prescription drugs covered?

PFFS Plan : Sometimes. If your PFFS Plan doesn’t offer drug coverage, you can join a Medicare Prescription Drug Plan to get coverage.

MSA Plan : No. You can join a Medicare Prescription Drug Plan to get drug coverage.


SNP Plan : Yes. All SNPs must provide Medicare prescription drug coverage (Part D).



Do I need to choose a primary care doctor?

PFFS Plan : No.

MSA Plan : No.






SNP Plan : Generally, yes, or you may need to have a care coordinator to help plan your care.



Do I have to get a referral to see a specialist?

PFFS Plan : No.
MSA Plan : No.
SNP Plan : In most cases, yes. Yearly screening mammograms and an in-network Pap test and pelvic exam (at least every other year) don’t require a referral.


What else do I need to know about this type of plan?

PFFS Plan :

■ PFFS Plans aren’t the same as Original Medicare or Medigap.
■ The plan decides how much you must pay for services.
■ Doctors, hospitals, and other providers may decide on a case-by-case basis not to treat you even if you’ve seen them before.
■ For each service you get, check to make sure your doctors, hospitals, and other providers will agree to treat you under the plan, and that they will accept the PFFS Plan’s payment terms.
■ In an emergency, doctors, hospitals, and other providers must agree to treat you.


MSA Plan :

■ Medicare MSA Plans have two parts: a high deductible health plan and a bank account. Medicare gives the
plan an amount each year for your health care, and the plan deposits a portion of this money into your account. The amount deposited is less than your deductible amount, so you will have to pay out-of-pocket before your coverage begins.
■ Money spent for Medicare-covered Part A and Part B services counts toward your plan’s deductible. After you reach your out-of-pocket limit, your plan will cover your Medicare-covered services in full.
■ Any money left in your account at the end of the year remains in your account along with the deposit for
next year.




SNP Plan :

■ A plan must limit plan membership to people in one of the following groups:
1) people who live in certain institutions (like a nursing home) or who require nursing care at home, or
2) people who are eligible for both Medicare and Medicaid, or
3) people who have one or more specific chronic or disabling conditions (like diabetes, congestive heart failure, a mental health condition, or HIV/AIDS).
■ Plans may further limit membership within these groups.
■ Plans should coordinate the services and providers you need to help you stay healthy and follow your doctor’s orders.
■ If you have Medicare and Medicaid, your plan should make sure that all of the plan doctors or other health care providers you use accept Medicaid.
■ If you live in an institution, make sure that plan doctors or other health care providers serve people where you live.