Know About The Medicare + Choice

Home / Financial Services / Know About The Medicare + Choice

Many people in America are unaware of the inherent benefits of Medicare Advantage program (previously known as Medicare + Choice). Under this a healthcare insurance scheme under which people eligible to claim benefits under Medicare can also take advantage of the benefits that a private insurance healthcare scheme offers them. Under this healthcare insurance scheme, the federal and state government pays a specified amount to the private healthcare insurer. In return, this insurer offers policyholders a variety of other advantages as per the guidelines and rules set by the Centre for Medicare and Medicaid Solutions. In many cases, the Medicare Advantages programs also contain provision for prescription drug coverage (Medicare Part D).

State Mutual Insurance Company under Dee Yancey is a prominent Legal Reserve Mutual Insurer whose ownership belongs to the policyholders who manage the company for the benefits of fellow policyholders. This company in Rome, Georgia offers its policy holders lucrative Medicare policies at competitive prices and has branches in forty one states including the District of Columbia

To the experts of this private healthcare insurance company explain that Medicare Advantage program has the following plans:

  • Preferred Provider Organization (PPO)

Many Medicare Advantage programs contain legally binding contracts with a network of private healthcare providers like hospitals, doctors, nursing homes and diagnostic clinics. These healthcare providers charge individuals who are eligible under Medicare subsidized rates for availing their healthcare services. Moreover, such individual can also avail the services of other private healthcare providers at an additional cost.

  • Health Management Organization (HMO)

This Medicare Advantage program also provides individuals eligible under Medicare healthcare coverage of a network of pre-approved healthcare providers. However, this particular healthcare insurance scheme differs from other Medicare plans because under this scheme the individual availing the service has to elect his/her primary care physician. This primary care physician not only acts as the individual’s personal medical practitioner also has his/her healthcare coordinator. In the event, the patient needs to see a medical specialist who is outside network of the individual’s HMO plans this primary healthcare coordinator makes a referral if necessary. Based on this referral, the individual’s insurance will bear a portion of the cost, which the individual otherwise have to incur in full.

  • Private Fee-For-Service (PFFS)

Private Fee-For-Service (PFFS) acts in a similar manner to the traditional Medicare. Under this scheme, an individual eligible to Medicare benefits can visit any healthcare provider that accepts the payment terms of the plan. These healthcare insurance plans provide a network of healthcare service providers for particular categories of service but allow policyholders to visit any healthcare provider outside the network who accepts the payment terms.

  • Special Needs Plan (SNP)

Special need plans are available for individuals eligible for benefits both under Medicare and Medicaid but are suffer from a chronic medical condition.

  • Medical Savings Account (MSA)

Under the Medical Savings Account, individuals do not have to healthcare insurance premium as the plan has a high deductible. However, individual eligible for Medicare benefit have to pay the premium under Part B and the healthcare services that Medicare covers. However, whenever such individuals reach a deductible, MSA plan pays for the Medicare services.

The experts at State Mutual Insurance Company and Dee Yancey explain the most important benefit of Medicare Advantage programs is that individuals eligible under Medicare do have to buy a Medicare Supplement Plan. Moreover, this healthcare insurance scheme offers ‘wellness benefits’ along with dental and vision coverage.