You’ll notice something as you start to look for Medicare Advantage policies in Lake Ozark — not all policies are created the same. Knowing which policy is right for you requires that you have an understanding of the advantages and disadvantages of the available options. That includes understanding the differences between the types of plans, the networks available, and the cost-saving structures of HMOs or hybrid options.
Here’s a breakdown of what you need to know and the available choices in terms of Medicare Advantage plans in Lake Ozark.
How is a Medicare Advantage Plan Different from Medicare?
Medicare Advantage plans are often known as the desired alternative to medicare because they include additional benefits that Medicare does not. For example, dental, vision, and hearing are all included at no extra cost.
Still, Medicare Advantage Plans come with some restrictions. Specifically, geographic limits. While traditional Medicare plans work nationwide, Medicare Advantage plans limit you to a specific geographic area. If you plan to do extensive traveling or long-term living away from the Lake Ozark region, you might need to obtain a Medicare plan. However, if you spend most of your time here in Missouri and the Lake Ozark area, a Medicare Advantage plan can offer you more coverage.
The Six Types of Medicare Advantage Plans in Lake Ozark
Qualifying for a Medicare Advantage plan is the first step. Deciding which plan you need for your individual health status and requirements.
So often, we hear our clients choose a Medicare Advantage plan based on what they have heard from a friend or neighbor or an ad they saw on television. While there’s value in talking to others about what’s worked for them, it’s essential to keep an open mind to find a plan that aligns with your specific needs.
The first step toward understanding those needs is to know what’s available. Let’s examine each available plan closer so you can start to understand the best options for your family.
Health Maintenance Organization (HMO) Medicare Advantage Plans
Health Maintenance Organization (HMO) plans are by far the most popular when it comes to Medicare Advantage plans. These plans will cover your care and medical services within a specific network of providers. In addition, you must obtain referrals to see specialists within your region.
If you go out of network, you will be asked to pay out of pocket. The exception to this rule is that patients may go out of network for emergency care.
Preferred Provider Organization (PPO) Medicare Advantage Plans
Approximately a third of people enrolled in Medicare Advantage plans have a Preferred Provider Organization, or PPO, plan. With this plan, you pay less to see providers within your plan’s network than you do with other plans. The out-of-pocket expenses limit at this time is $5,873 for local PPOs and $6,707 for regional PPOs. In addition, some plans charge an annual deductible for both medical care and drug coverage, but most do not.
If you have a provider you want to continue seeing, be sure they are approved for this plan before you sign up. We often encourage our clients to do their due diligence when determining whether their provider is in their PPO network. Talking directly with a doctor can help you verify that you’ll continue to be covered. Relying on Medicare Advantage plan websites can be problematic, as oftentimes, that information is outdated or inaccurate.
Private Fee-For-Service (PFFS) Medicare Advantage Plans
Private fee-for-service (PFFS) plans are far less common than HMOs or PPOs. These plans also have a network of providers available. If you want to go to a doctor or hospital that is out of network but that accepts Medicare and your plan’s terms and conditions, you may.
While that sounds good, problems arise when a provider rejects the PFFS plan. Not all health providers who accept Medicare will go along with this plan’s policies, so you’re still limited in your choices. In addition, medical providers can accept or reject the PFFS plan on any visit. That means you’ll need to reverify that the provider will accept your plan before every trip to the doctor.
Another limitation of this plan is prescription drug coverage. Most plans do not include this type of coverage, so you could be paying out of pocket for your prescriptions.
Special Needs Medicare Advantage Plans
Special Needs Plans (SNPs) are available for anyone requiring specialized care, such as individuals with chronic conditions. Because the type of coverage on these plans is so specific, many people who get an SNP aren’t given much of an option. This plan tends to be the clear-cut choice for the type of care they require.
In addition, many people who have an SNP:
- Have dual eligibility for Medicare and Medicaid
- Have a chronic or disabling condition, such as diabetes or heart failure
- Live in a nursing home or assisted living facility
Medical Savings Account (MSA)
Medical Savings Accounts (MSA) are plans where you pay high deductibles on your health care out of a savings account dedicated to medical care. Similar to a health savings account, your plan will regularly deposit funds into the MSA. These are not common because there are so few MSA plans offered, and these plans do not include prescription drug coverage.
HMO Point-of-Service (HMOPOS) Medicare Advantage Plans
HMO Point-of-Service (HMOPOS) plans are another unpopular type of Medicare Advantage plan. This plan is a combination of an HMO and a PPO. The guidelines state that you must stay within the network to have medical care or services covered by your plan. If you want to go out of network for coverage, you must pay more for that care. There are two separate deductibles for in-network and out-of-network charges.
Which Lake Ozark Medicare Advantage Plan is Right For You?
With so many options to choose from, it can be hard to know which Medicare Advantage plan in Lake Ozark is the right one for you. Talking to someone well-versed in each of these plans and who knows what’s available here in our Lake Ozark region is beneficial. Schedule a consultation with us to discuss your family’s interests and needs, and discover which options will align best for your situation.
