You may select a Medicare Advantage option if you are entitled to Part A and enrolled in Part B of Medicare, you do not have end-stage renal disease, and you live in a geographic area served by the option.
The Medicare Advantage options include:
Health Maintenance Organizations (HMOs): HMOs provide or make available health care services that may include preventive medical care and pharmacy services for which an enrolled person pays a pre-determined monthly rate. HMOs are available to those persons living in specified geographical areas. Generally, members must receive health care services from the HMO staff at a designated HMO facility, although some emergencies are covered at facilities outside the normal service area.
Preferred Provider Organizations (PPOs): Generally in a PPO you can see any doctor or provider that accepts Medicare. You don’t need a referral to see a specialist or any provider out-of-network. If you go to doctors, hospitals or other providers who aren’t part of the plan (out-of-network or non-preferred), you will usually pay more.
Private Fee-For-Service (PFFS) Plans: Medicare Private Fee-for-Service Plans are fee-for-service plans offered by private companies. The general rules for how Medicare Private Fee-for-Service Plans work are below:
- You can go to any Medicare-approved doctor or hospital that accepts the terms of your plan’s payment.
- You may get extra benefits not covered under the original Medicare plan, such as extra days in the hospital.
- The private company, rather than the Medicare program, decides how much it will pay and what you pay for the services you get.
- If you’re in a Medicare Private Fee-for- Services Plan, you can get your Medicare prescription drug coverage from the plan if it’s offered, or you can join a separate Medicare Prescription Drug Plan to add prescription drug coverage if drug coverage isn’t offered by the plan.
Medicare Savings Accounts (MSAs): Medicare MSA Plans have two parts: a high-deductible plan and a bank account. Medicare gives the plan an amount each year for your health care, and the plan deposits a portion of this money into your account.
Special Needs Plan (SNPs): SNPs serve people who either 1) live in certain institutions (like a nursing home) or who require nursing care at home, or 2) are eligible for both Medicare and Medicaid, or 3) have one or more specific chronic or disabling conditions (like diabetes, congestive heart failure, mental illness, or HIV/AIDS. There is currently only one available in our state which is in the greater Ardmore area.
Take Note: Many Medicare plans and their contracted agents and brokers will offer sales seminars prior to the Annual Enrollment Period which runs from October 15 to December 7. For your protection, please take note that Medicare Advantage (MA) organizations may not solicit nor accept the submission of paper enrollment forms or accept telephone or on-line enrollment requests prior to the beginning of the Annual Enrollment Period on October 15. Brokers and agents under contract to Medicare Advantage organizations may not accept or solicit submission of paper enrollment forms prior to October 15. Medicare Advantage organizations and their brokers and agents also should remind beneficiaries that they cannot submit enrollment requests until October 15.