When It Comes To Medicare, There Are Four Different Types, Namely A, B, C, and D. Whereas Parts A and B are traditional, Medicare Advantage Plus is Referred to Parts C and D.

Medicare is a social insurance offered by the US government to Senior Americans, permanent residents of the US who have lived in the country for 5 consecutive years and are 65 years of age or older, ensuring that these individuals have free health care access for any medical conditions. The US Federal Government guarantees this access, and extends it to people with disability and those with end-stage renal disease regardless of age. Medicare is grouped into four parts, namely Parts A, B, C and D. The first two parts comprise the traditional Medicare, in which enrollees are given free access to hospital care (Part A) and outpatient medical services (Part B). Currently 74% of the entire enrollees in Medicare are under traditional Medicare, whereas the 24% of the remaining Medicare enrollees enjoy extra services under the provisions of the Medicare Advantage Plus (Parts C and D). In Medicare Advantage Plus, enrollees pay an extra amount to private companies, termed Medicare Advantage Organizations, so that they are able to gain added services like vision care, dental care and preventive health services.

Medicare Advantage Plus have different types which include health maintenance organization (HMO), special needs plans (SNPs), private fee-for-service (PFFS) plans and preferred provider organization (PPO). Most HMO plans restrict its enrollees to access health services that are recognized and are members of the network; these plans also usually include the cost of prescription drugs as part of the benefits package. Enrollees under HMO plans would also require referrals and approvals for certain procedures to be conducted, and in case your physician leaves the network, you will have to select another one who is a member of the network. PPO plans do allow its enrollees to see physicians or go to hospitals that are not included in the network; however, these patients will have to pay higher compared to patients who use physicians, hospitals and health care providers that are members of the network. PPO plans do not require that the patient get referrals to see specialists or undergo certain procedures; patients are simply warned that they will have to pay more for services received from health care providers not in the network. PPOs usually include the cost of prescription drugs as part of its benefits package. Enrollees of the PFFS plans generally enjoy the same benefits as those under PPOs; these patients may visit any physician, hospital or health care provider of their choosing.

However, one unique characteristic of PFFS plans is that a physician or hospital you have gone before may refuse treatment or any other services you require the next time you visit. Patients under PFFS plans may not use their Medicare card to pay for the medical services they require, though they are advised to keep their cards in case they decide to revert back to traditional Medicare. Patients enrolled in PFFs plans are further advised to ensure that their physicians, hospital or health care providers agree to provide service to them under the plan and accept the payment terms of the PFFS plan. Those with this type of Medicare Advantage Plus coverage can opt to include prescription drugs to be part of the benefits package. SNPs share common characteristics with HMOs and PPOs, though enrollees of SNPs may be able to tailor-make the services that they require out of the Medicare Advantage Plus plan, depending on the medical condition they may have, as well as the required diagnostic and treatment procedures and drug formularies. SNPs always have prescription drugs as part of the plan, and enrollees of SNPs are strongly advised to have a primary care doctor or a care coordinator that should help them with their medical needs. The plan limits membership of the enrollees to any of these groups: 1) people living in institutions or are cared for at home; 2) people having both Medicare and Medicaid; and 3) people with special disabling conditions (ESRD, HIV/AIDS and dementia).

Some less common Medicare Advantage Plus types are HMO Point of Service plans and Medical Savings Account plans. The HMO Point of Service plans allow patients to be able to access health services that are outside of the HMO network, whereas the Medical Savings Account plans involves money deposited by Medicare into the enrollees bank account and funds getting deducted from it depending on the health care utilization of the person.