Special Needs Plans (SNPs)
Special Needs Plans (SNPs) are available to those who qualify for both Medicare and financial help. Features of this plan include:
- In-network care (unless for emergencies or out-of-area dialysis)
- Full prescription drug coverage
- Primary care doctor
- Limited membership requirements (must also meet financial requirements)
Preferred Provider Organization (PPO) Plans
Preferred Provider Organization (PPO) plans are another Medicare Advantage option. Compared to other options, this plan is one of the most flexible options, but at a slightly higher cost. This plan:
- Allows for out-of-network visits
- Covers most prescription drugs
- Does not require a primary care doctor
- Does not require specialist referrals
Health Maintenance Organization (HMO) Plans
Health Maintenance Organization (HMO) plans are one of the least expensive options. Its main features include:
- In-network care (except for emergency visits, out-of-area urgent care, or out-of-area dialysis)
- Prescription drug coverage (included in most plans)
- Required primary care doctor and specialist referral
Private-Fee-For-Service (PFFS) Plans
Private-Fee-For-Service (PFFS) plans allow you to have more control over your care coordination and costs. When you need healthcare, you negotiate the insurance cost and coverage with the healthcare provider. This plan:
- Allows out-of-network care by those who accept the plan’s terms
- Covers prescription drug coverage (depending on the provider)
- Does not require a primary care doctor
- Does not require specialist referrals
Medicare Medical Savings Account (MSA) plans
An MSA plan has a high deductible health plan and a bank account. Once the high deductible is paid off, the health plan will cover your medical expenses for the rest of the calendar year. As for the bank account, the plan provider will deposit funds into the account each year for your medical costs. These funds can be used to pay on the deductible.
It’s important to note that these plans typically have provider networks and do not include prescription drug coverage.
Medicare Advantage Enrollment Requirements
To be eligible for Medicare Advantage, you must be first be enrolled in Original Medicare (Parts A and B). You also cannot be enrolled in a supplement plan—for these additional coverage options, you must choose between one or the other.
You can enroll in Part C at any time during the Annual Enrollment Period (AEP). Providers cannot legally turn you down for health, age, or other issues. However, your rates will be higher based on these factors.
Insurance can never be one-size-fits-all. When looking at Medicare Advantage plans, you must understand how your options fulfill your healthcare and budget requirements.
But understanding the ins-and-outs of Medicare is impossible without help. That’s why we want to help—with a personalized quote from one of our experts, you can choose a Medicare plan with confidence.
We have spent years meeting the needs of our clients throughout Oklahoma, and we can do the same for you. When you’re ready to get started, call Weller Insurance Services at 405-721-2021.
