The original medicare advantage is from private medical insurance companies. The Affordable Medicare Advantage is suggested by most of the trusted insurance agents. There various plans within the medicare advantage plan like HMO or health-maintenance organization, preferred provider organization or PPO, Medical Savings account or MSA, Private fee for service or PFFS, Special needs plans, or SNS, and health maintenance organization and point of service plan or HMO-POS. These plans are unique and are designed for catering to different needs of patients.
- Health-maintenance organization plan (HMO) – To see the in-network doctor, without paying extra expense. An HMO, the patient can get out of network doctor or medical health care but it will cost higher copays. In case of emergency, the patient gets the health care irrespective if the doctor will accept to the terms and conditions or not. Here, you may not get the in-built prescribed drug plan. The patient can get Part D for that. Also, the patient needs a referral to see a specialist.
- Preferred Provider Organization plan (PPO) – The patient can choose any doctor, as long as they accept the medicare facility. Within the PPO, if you choose a plan without the drug plan then you won’t get the coverage. The patient can go to out of network doctor but may have to pay more. There is no need for a referral to see a specialist.
- Private fee for service plan (PFFS) – The doctor should be accepting of the terms and conditions of payment, else the plan will not cover doctor’s fees. The plans usually cover the drug plan. The patient can see a doctor that adheres to the terms and conditions of the plan. The referral might vary with the plan.
- Special need plan (SNS) – This plan has prescribed drug coverage and is useful for those with special needs. It also holds good for someone with chronic diseases like end-stage renal disease or HIV/AIDS. Here, you will not be able to use health care providers or doctors from the outside networks as it may not tend to the specialization. Only in case of emergency or with ERSD the patient cannot be denied immediate support even though if the doctor does not agree with the terms of the plan.
- Health maintenance organization- point of service plan (HMO-POS) – It covers both in and out network health care facilities, so whenever a patient goes to the doctor they need not pay out of their pockets.
- Medical saving account plan (MSA) – This provides deductible with a bank account, where the money gets deposited in that account. The deposited amount varies from plan to plan. It does not have any monthly premium. It also does not have an in-built prescribed drug plan. The patient needs to buy a Part D plan for a better plan for prescribed drug coverage.
There is a whole bouquet of plans for someone who wants a change from medigap plans. Most of the companies including medicare advantage 2022 have a bright future with enormous development.