NW Florida Medicare Serving the Panhandle

Medicare Advantage Plans

Medicare Advantage Plans are plans offered by private insurance companies. They more or less replace the way you receive your Medicare Benefits. The only requirement for a Medicare Advantage Plan is that it must offer equal or better benefits than Original Medicare Part A and Part B.

Medicare Advantage Plans often come with a $0 premium in Florida and in Alabama. There are a few plans with a monthly premium, but not many. Most all of these plans offer the benefits of Original Medicare and additional benefits such as Dental, Vision, Hearing, Fitness Memberships and Over the Counter medications, as well as a Part D prescription plan included (MAPD) Medicare Advantage Prescription Drug.

The thing to remember is that (MA) Medicare Advantage although they are $0 premium there are co-payments for everything. Some are much lower than Original Medicare and some are the same 20% you would be responsible for with Original Medicare.

The other piece of protection they offer is a (MOO) Maximum Out of Pocket cost. Usually between $3900 and $6700 per year. This simply means if all of your cost share added up to the MOO, then all of your medical care would have $0 cost for the remainder of the year,

Medicare Advantage PPO

Medicare Advantage PPO Plans are certainly the most flexible plans. PPO stands for Preferred Provider Organization. A PPO still has a network of Physicians and Facilities, but you can go out of network and see a provider if the agree to accept your plan benefits. There is usually a higher co-payment associated with out of network providers. 

PPO plans usually have higher co-payments than their HMO counterpart. They also often times have fewer extra benefits than an HMO Plan. But, if you are someone who wants more personal control over your health or you are someone that likes to travel and want access to providers when you are on the road, then a PPO might be for you.

  • Networks, but may travel outside network.
  • Extra benefits (usually less than HMO)
  • Higher co-pays in and out of Network
  • Allows you to choose physicians and facilities
  • Manage your own Healthcare
  • Use doctors and facilities while traveling

Medicare Advantage HMO

Medicare Advantage HMO Plans typically have the richest benefits of the Medicare Advantage Plans. HMO stands for Health Maintenance Organization. An HMO is made of of a network of providers who contract with the insurance companies to provide service for a set fee. HMO Plans usually require you to utilize your (PCP), Primary Care Physician, as a gateway provider. Simply meaning they are the ones that make referrals to other providers instead of you picking up the phone and calling a Specialist yourself. 

Co-payments are usually less with an HMO and often times more extra benefits are provided. These plans do provide emergency care if you are out of network, eg. traveling to another state. For people who mainly stay local and do not need a travel option plan, HMO’s can be a great fit. 

  • Networks, but may travel outside network and receive emergency care.
  • Extra benefits (Fitness, Vision, Dental, OTC, Acupuncture, and many more depending on plan)
  • Lower co-pays in Network
  • PCP makes referrals
  • Managed Care
  • Use emergency services while traveling

Medicare Advantage Veteran Plans

Medicare Advantage Veterans Plans are a great option for our Veterans who receive VA benefits.

Veteran Plans usually forego the added Prescription Drug portion of an MAPD, so they are MA, Medicare Advantage, only. Most veterans get their medications for Free or at a reduced cost from the VA and do not require the drug portion of a MAPD.

So in return of not requiring the drug portion, many of the plans are giveback plans that pay $50-$70 of your Part B premium monthly. So not only do you get to see civilian doctors and get the extra benefits, but you get money back. Veteran plans can be either PPO or HMO and offer the same benefits as a non-veteran plan.

With the long waits and limited care that the VA offers Veterans these plans make an excellent choice.

Medicare Advantage PFFS

Medicare Advantage PFFS plans allow you to choose your provider if they agree to accept the benefits. They may have networks which lower the cost, but you are allowed to go out of network and see a provider.

PFFS plans offer extra benefits similar to other HMO and PPO plans. You can ask if your PFFS plan can offer a Part D, if not you may be eligible for a stand alone PDP.

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