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Which Type of Medicare Advantage Plan is Right for Me?

One significant advantage with many Medicare Advantage (Medicare Part C) policies is the ability to have access to most of your Medicare benefits through a single plan. In reality, traditional Medicare (Medicare Part A and Medicare Part B) programs don’t always provide all the healthcare coverage seniors might want. Trying to coordinate coverage on their own and identify what multiple supplements they might need – including, perhaps, separate prescription drug coverage (Medicare Part D) – can be hard to do. Having a single Medicare Advantage plan to manage most of their healthcare needs is what many people prefer.

Certainly, no one Medicare Advantage plan could possibly satisfy every need. So insurance companies have set up a number of different Medicare Advantage policies. This allows you to choose the policy you decide is most suited to your needs and consolidate your healthcare coverage under it. Result? You’re likely to find it much easier to manage your expenses.

Most Medicare Advantage plans fall into one of several categories, including …

Health Management Organization (HMO) plans
Under HMO plans, you need to select a primary care physician, and you’re restricted to receiving services from medical professionals and facilities that are part of that plan. Your primary care physician would manage your care and arrange referrals to specialists as you need them.

Point of Service (POS) plans
These policies are a type of HMO plan under Medicare Advantage that has increased flexibility in terms of which medical professionals or hospitals you able to visit outside the network. Some POS plans may not even require that you get a referral from your primary care physician. There is a down-side, though. This type of flexibility often requires you to pay a higher copayment or spend more for coinsurance.

Preferred Provider Organization (PPO) plans
If you’re truly interested in greater flexibility, this type of plan may be right for you. On the whole, it gives you more flexibility in selecting a doctor, usually doesn’t require you to obtain a referral in order to make an appointment with a specialist, and allows you a wider range of care choices – in pharmacies, clinics, hospitals, and so on – as long as they’re part of the Medicare Advantage provider network.

Special Needs Plans (SNP)
These plans were developed to care for seniors who have atypical or narrowly defined – i.e., “special” – needs. The special needs involved could be disease-specific (like diabetes) or need-specific (relative, say, to the needs of a long-term care facility resident). SPNs might require members to use medical professionals and facilities that are on the plan. Nevertheless, the benefits of the plan are personalized to address the patient’s special needs.

Private Fee for Service
If you don’t want a primary care physician coordinating your care, this may be the right option for you. Plan participants have the flexibility of getting care from any Medicare-eligible provider who accepts the various conditions, terms and rates associated with the plan.

Keep in mind that while Medicare Advantage plans offer a variety of different options and provide a great range of flexibility when it comes to managing your care, not all plans include prescription drug coverage. When looking into these plans, you should determine how important prescription drug coverage is to your day-to-day budget and ensure your choices reflect your needs.

No matter what plan you choose, Medicare Advantage provides a number of ways for seniors to exercise some control over their healthcare costs. Don’t forget understanding the advantages and disadvantages associated with the individual plans takes experience. Contact Sun Coast Legacy Advisors. Our insurance agents are Medicare Advantage professionals who can provide the answers you need to make an informed decision.

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