Over the past few years Medicare Advantage (also called MA) plans have become very popular in Arizona because the premiums are very low or nothing at all. There are three distinct types of MA plans; HMO, PPO and PFFS. Arizona Medicare Advantage Plans are annually renewable contracts between you and the insurance company. Unlike Medicare Supplements, your enrollment can never be turned down for coverage due to any preexisting health conditions. Many companies that offer these MA plans even have special need plans for those with chronic conditions, to further help them with their medical costs. Another nice feature of the MA plan is that they are available with a prescription drug plan at no additional cost. These types of plans are often referred to as MAPD plans.
Medicare Advantage plans are heavily advertised by the insurance companies during the two open enrollment periods AEP and OEP. AEP is the annual enrolment period currently starting from November 15th and runs through December 31st each year. During this time period Medicare recipients can freely switch from one MA and or PD plan to another with a policy start date of January 1st. OEP is the open enrollment period and runs from January 1st through March 31st of each year. During this time period Medicare recipients can once again change plans and providers with one limitation they can not add a drug plan if they do not already have one.
HMO’s are health maintenance organizations. Like many health plans in Arizona you are limited to the contracted health care providers and facilities the company has in their directory. These plans provide for limited or no coverage outside of the company directory unless you have an emergency that requires immediate hospitalization. These types of plans require that you designate a primary care physician or (PCP) who is contracted with the company. They are your single source for health care with a few exceptions, such as urgent care and emergency care. If you need a specialist or surgery they will be the ones to refer you to other providers within the organization. One of the reasons many people who choose this type of plan enjoy it (besides the good service they receive) is the cost. Currently, the monthly premium for an MAPD in Maricopa County Arizona is zero.
PPO’s are preferred provider organizations. They are similar to the HMO style plan except that you have the freedom to choose any health care provider, service or facility within the directory without a referral from a PCP. Many insurance companies offer both HMO and PPO style plans to their Medicare Advantage members. Though the freedom of a PPO comes with the extra expense of a monthly premium, it is an excellent choice for those who want the freedom to pick and choose without having to be referred by a PCP. These plans will also save you on your monthly premium compared to a traditional Medicare Supplement. Like the HMO plan Part D is included for no additional expense. The PPO plan is a very good fit for Arizonans who live in multiple covered counties at different times of the year.
PFF’s are Private Fee for Service Plans. This type of MA plan has only one major limitation. The provider you use for services must be willing to accept the insurance companies’ payment for services performed. If your provider is willing to accept the terms and conditions of the PFFS insurance carrier you are only responsible to pay the co- pays as described in the plan’s summary of benefits.
If you’re considering a Medicare Advantage plan it is important to know that they are all not the same. Comparing plans and benefits from two or three different providers is always in your best interest. You should consult with an independent insurance agent so you can choose the plan that fits your needs and your budget.