People with Medicare can obtain their medical care through original Medicare or the Advantage Program (Part C). Advantage Plans consist of HMO, PPO, Private Fee for Service Plans and Special Needs Plans. Of the more than 10 million individuals enrolled in Advantage Plans, the majority are enrolled in HMO’s (Health Maintenance Organizations) which have been available since the 1980’s. To help your parents (or you) make an informed decision, they need to understand how these plans work, and then decide which plan is right for them. The following is a brief description of the HMO and PPO plans.
HMO’s (Health Maintenance Organizations)
These plans cover the same physician and hospital costs as the traditional program, but usually with lower out of pocket costs. HMO’s are attractive to individuals with Medicare eligibility because they often provide extra benefits like eyeglasses, hearing aids, and dental benefits which are not covered by the traditional program. Individuals considering a HMO should be aware that they can only receive medical services from providers who are part of the HMO’s network of contracted providers.
PPO’s (Preferred Provider Organizations)
These plans are private healthcare plans like HMO’s. Regional PPO’s are available in many areas of the country. These plans serve large geographic areas and must offer the same premium costs and plan benefits to all individuals residing in these areas. PPO’s cover the same types of medical expenses that the traditional program does. In addition, PPO’s commonly include a prescription drug benefit. Unlike the traditional program, PPO’s have an annual out of pocket limit for benefits covered under Parts A and B.
The Difference Between HMOs and PPOs
PPO’s and HMO’s do differ into two very important areas. First, PPO’s do cover eligible medical care services obtained from doctors and hospitals outside the PPO network. And, second, PPO’s do not usually require that you obtain an authorization before seeking care from a specialist. Get your health insurance Florida from a specialist and start being covered right now. Before you enroll in a plan you need to investigate the network thoroughly. No one has a crystal ball, but doing some research before you enroll can give you a better idea about what services are available.