Medicare Advantage plans work different than Medicare Supplement plans, and they are divided in to 2 major groups, HMO's and PPO's. Although very similar in features and benefits, the mechanics of how this plans work are very different than Medigap plans.

First and foremost, there are no networks on a Medigap plan, where on an Advantage plan you will have a network of doctors and hospitals and depending upon which plan you select , you may need to stick strictly to the network.

The biggest difference between an HMO and a PPO is that on an HMO you will have to strictly to the doctors in the network, you will have to select a primary doctor, and your primary doctor will be the one that will have to give you a referral to go to any specialist, but the upside of the HMO's is that most of the times the copays to see doctors or to go to the hospitals will be lower than on the PPO's. In contrast the PPO's are more flexible in the sense that you will not need to select a primary doctor or a specialist, you can simply select any doctor within the network and go without the need of a referral, and in certain cases you can even go to some doctors that are not part of your network as long as the doctor is willing to accept the plan terms and conditions, but you will pay a higher copay in most cases and perhaps even a deductible for doctors that are out of network.

The other significant difference is that in most Medigap plans there are no copays whatsoever, were on the Medicare Advantage plans you have to pay co-payments for many things such as hospitalizations, doctors visits, diagnostic testing such as MRI's Cat scans, physical therapy, and Chemo.

For more information or questions, call us at 888-801-9097

 
Posted 3:41 PM

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