Medicare Advantage plans are not going to be fully accepted in as many places as the basic Medicare plan or even Medicare Supplements. You cannot go to just any and every medical care facility in the country that accepts Medicare and expect to receive full coverage from your Advantage plan. That isn’t how these plans work. They only provide you with full benefits if you go to a healthcare provider who is on your insurance company’s network. That means that they have an agreement with your insurance company and will honor their Advantage plan in full.
So, what happens if you go outside of the network for your care? Are you responsible for all of your medical expenses and not helped at all by the insurance plan that you are paying for? Well, that is going to vary based on which network option you choose.
You see, in addition to offering different benefit plans, insurance companies can also offer different network options for their Medicare Advantage plans. When you search our site and see a list of Medicare Advantage plans, then you will often see names like HMO or PPO attached to the plans. Not everyone is familiar with these designations, so we will break them down for you.
HMOs- The cheapest option for most people, these are widely available and only cover you on the network. They provide zero coverage for off-network medical care. The only time you receive coverage outside of the network with an HMO is in the case of a medical emergency where you have no choice as to which healthcare facility you go to for treatment.
PPO- This kind of network option is a bit pricier, but it gives you more extensive coverage. PPOs will provide you with full coverage on the network and then partial coverage outside of the network.
HMO-POS- Many seniors like the flexibility that this kind of plan provides them. HMO-POS plans are able to give seniors full coverage while they are on the network and then provide a discount on medical services outside of the network. This is not a very common option, however.
Special Needs Plans- This is another kind of rare network option, but it is also the cheapest one available. You can qualify for these if you meet the enrollment qualifications for Medicare and Medicaid both. Be sure to talk to us to find out more and see if a Special Needs plan is suitable for you.