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Navigating Medicare Advantage plans

September 20, 2023 by HAP

Making informed decisions about your Medicare coverage is essential. It's important to understand the different types of Medicare Advantage plans available to you. Knowing the differences between HMO, PPO, HMO-POS and D-SNP plans will help you make the right choice for your health care needs. 

Everyone has different health care needs and expectations. When trying to decide which health care plan is best for you, there are many factors to consider, with some of the most important being flexibility, cost efficiency and coordination of care. 

If flexibility is most important, then a PPO (Preferred Provider Organization) insurance plan might be a better fit for you. PPO plans allow more control over which providers you see and when. If you are looking at cost-efficiency, an HMO (Health Maintenance Organization) plan might be best because, most times, an HMO plan is a more affordable option. Another benefit to an HMO plan is that it requires a primary care physician that coordinates care for you.

Weighing the pros and cons: which Medicare Advantage plan fits your lifestyle? 

 HMO Plans
Pros Cons
  • Personalized care: You select a Primary Care Physician (PCP) who manages your health care needs. 
  • Cost savings: HMOs (Health Maintenance Organization) typically offer lower monthly premiums and out-of-pocket costs. 
  • Limited network: Your out-of-network options are limited or restricted. 
  • Higher costs out-of-network: You may have to pay 100% for health care services received outside of the network.

 

 

PPO Plans 
Pros Cons
  • Provider flexibility: PPO plans offer more flexibility when it comes to choosing your health care providers. You do not need to select a PCP and referrals are not usually necessary for specialist visits.
  • Out-of-network access: You can see out-of-network doctors and hospitals, even though it may be at a higher cost. While PPO plans generally have higher monthly premiums, they offer a greater choice of providers. 
  • Increased responsibility: You have more responsibility for managing and coordinating your care. 
  • Higher costs: Deductibles and monthly premiums may be higher. 

 

 

 HMO-POS Plans
Pros Cons
  • Provider flexibility with referrals: HMO-POS (Point of Service) combines options for both HMO and PPO plans. Like an HMO, you choose a PCP and need referrals for specialists within the network. 
  • Lower premiums: These plans offer a balance between lower monthly premiums and increased provider flexibility. 
  • Out-of-network costs: If you require care from out-of-network providers, you may pay a higher cost.

 

 

 D-SNP Plans
Pros Cons
  • Medicare-Medicaid coverage: D-SNP (Dual Special Needs Plan) plans are specifically designed to cater to individuals who are eligible for both Medicare and Medicaid. 
  • Additional benefits: These plans offer additional benefits and special care coordination. 
  • Lower costs: Monthly premiums and out-of-pocket costs for D-SNP plans are typically lower for those who qualify.
  • Varied benefits: Benefits and services may very by plan and where you live. 
  • Limited providers: Since many D-SNP plans are HMOs, your provider options are limited.

 

 

Choosing a Medicare Advantage plan requires balancing your preferences, costs, and additional benefits.

 

Ready to learn more about HAP Medicare Advantage plans?

Compare Medicare Advantage Plans: Compare different Medicare Advantage plans side by side and find the one that fits your health care needs and budget. If you need further assistance, our Medicare experts are available at 888-747-8551 (TTY:711) to help you make an informed decision and take the Medicare Advantage preference quiz for personalized recommendations.

Contact HAP's Medicare Experts: Call our knowledgeable Medicare experts at 888-747-8551 (TTY: 711) April 1 through Sept. 30: Monday - Friday, 8 a.m. to 6 p.m. Oct. 1 through March 31: seven days a week, 8 a.m. to 8 p.m.to get personalized guidance and answers to your Medicare Advantage plan questions. Additionally, they can help you compare different plans and assist you in taking our Medicare Advantage preference quiz to find the perfect plan for you.

Remember, when it comes to your health care, making an informed choice is key. Let HAP be your trusted partner on this journey. 

 

Please note: The specific details and benefits for each plan type may vary. It is essential to consult with HAP's representatives or review plan documents to get accurate and up-to-date information about the available Medicare Advantage options. 

Health Alliance Plan (HAP) has HMO, HMO-POS, PPO plans with Medicare contracts. HAP Medicare Complete Duals (HMO D-SNP) is a Medicare health plan with a Medicare contract and a contract with the Michigan Medicaid Program. Enrollment depends on contract renewals.

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Categories: Get To Know Your Plan