Basics for Medicare Patients II
By Tucker Thompson, Collin County LIVING WELL Magazine
What are some of the differences between traditional Medicare Supplements and Medicare Advantage Plans?
Medicare Supplements––Freedom to choose any hospital or doctor that accepts Medicare. No networks. No referral for a specialist is required. No authorization for hospital and medical services. Supplement plans co-insurance and Medicare deductibles vary with which plan you choose.
Medicare Advantage Plans [HMOs, PPOs, SNPs] you have to use physicians and hospitals in their network. HMO’s members have to use their Primary Care Physician first regardless of your health or condition before you can see a specialist in their network. You must have prior authorization for hospital and medical services in their network except emergencies. Co-pays and deductibles vary with the plans. Out-of-pocket costs vary from $2,500 to $10,000 with these plans.
What are Medicare Advantage Plans?
Part C Medicare Advantage Plans include Health Maintenance Organizations [HMO] Plans, Preferred Provider Organization [PPO] Plans, Private Fee-for-Service [PFFS] Plans, Special Needs Plans [SPN]. Medicare pays an amount of money every month to these private health plans, whether or not you use their services. You are still in Medicare and in most cases continue to pay Part B and sometimes Part A premiums.
Which cards do I show?
If you enroll in a Medicare Advantage Plan, you only show this membership card, NOT your Medicare card. The Advantage Plan becomes your primary insurance. Medicare should not be billed while you are a member of a Medicare Advantage Plan because the Advantage Plan pays the bills. Only carry and present your Medicare Advantage Plan membership card to prevent errors in billing!
What is a “Network”?
Network means hospital, facilities, and providers contracted by Medicare Advantage Plans to provide services and supplies to its members. Make sure the hospital and doctors you like are in the network before signing up!
With Medicare Advantage Plans do I need prior authorization for hospital and medical services?
Yes, almost always! Treatments, procedures, services, surgeries and or drug therapies will not be paid by your Advantage Plan or Medicare unless you have gotten prior authorization from your Medicare Advantage Plan, primary care physician, or specialist. An exception will be made for Emergency Services.
Tucker Thompson, the author, has worked in the insurance field for over 21 years. His time is spent helping individuals review or enroll for new medical, Medicare Supplements, Medicare Advantage Plans, Medicare Prescription Drug Plans, Life and Long Term Care polices.