Skip to main content

Medicare Advantage Plans - HMO / PPO

(A general summary of how they work - please refer to CMS approved marketing materials for specifics of Medicare Advantage plans offered by specific companies – I can provide you with these materials)

Mount

Medicare Advantage Plans – HMO / PPO

 (A general summary of how they work - please refer to CMS approved marketing materials for specifics of Medicare Advantage plans offered by specific companies – I can provide you with these materials)

Originally designed to reduce Medicare Costs and provide additional benefits not covered by Medicare.

  • Lower premium than Medicare Supplements and not tied to age
  • HMO plans have a “Gate Keeper” that you must go through in order to receive services at lower co-pays. HMO plans require the use of network providers, PPO & POS plans allow the use of non-network providers; just keep in mind that out of network services will cost you more money.  PPO Plans are a much better choice than HMO plans because you can see out of network providers, again at higher co-pays all along the way.
  • Same coverage as with Original Medicare with additional benefits
  • Cost sharing – you have co-pays all along the way – this is why the premiums are lower!
  • Beware of the Excess charges and out of pocket Maximums in Medicare Advantage Plans. Some have different out of pocket maximums for in and out of networks services.  Some do not protect you from Excess Charges that providers can charge (15% of the Medicare amount).
  • You will have no choices when it comes to prescription drug plans – you have to take the drug benefits offered by the plan. Remember if you cannot choose drug coverage among several companies you will most likely not be getting the best buy.
  • Providers can choose not to participate with these plans from time to time. (You may have to switch doctors occasionally)
  • These plans change their benefits each year as they re-file the plan with Medicare. Beware! – the plan you purchase today will look different in five years.
Medicare Made Easy

The premium for a HMO/PPO plan is certainly attractive – I recommend that you select a PPO plan over an HMO or PFFS plan if you do choose Medicare Advantage.

 

You must have both parts A and B of Medicare.

 

You need to take a look at your current health conditions and your family history and choose the plan that offers the benefits that you want.

Compare potential costs in addition to the Part B Medicare premium.

  • Plan G – Monthly premium + Coverage (2025 $257 deductible)
  • HMO/PPO – a lower monthly premium + Co-pays all along the way.
  • Plan G allows you to choose from many drug plans – HMO/PPO Plans have a single choice.
  • Either way the medical provider submits only one claim and you do no paperwork.

The outlines of coverage for each specific plan will tell you much more.

Before you choose any Med Advantage Medicare Health plan – Please let me show you how to sort them all out.  This will save you a great deal of time and frustration.  I have low cost indemnity plans to cover the high hospital and equipment costs buried in these types of plans.  I really think you will end up happier with a Plan N supplement if you like the way these plans work.

 

Most choose plan G when they can afford the premium.

 

My objective is to help you be an informed consumer, answer questions that you have and offer the coverage you desire at the lowest possible premium.

NOTE:  The billings from these kinds of plans get confusing at times – Do you want this?

Do you ride the bus OR do you drive a car?

image

Think of a Medicare Advantage plan like riding the bus.

It may cost a little less than owning a car, but you have to put money in the bucket every time you use it.

You have to get on and off where the bus says to get on and off and if you go off the scheduled route it is going to cost extra.

image

Think of Plan G and N Medicare Supplement plans like driving a car.

You get to go where you want when you want.  It may cost a little bit more to operate a car; however, the luxury of the freedom that you get with that is definitely worth it.

Remember what your mom told you as you were growing up?

You get what you pay for!

 

If you are hardly paying a premium for one of those Medicare Advantage plans, then there may not be as much advantage in it as you probably think.  For a good example - Look into the cost of cancer treatments and part B medications!