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Medicare Advantage plan

Q&A: Benefits of Medicare Advantage HMOs

February 10, 2025 By Liz Weston

Dear Liz: You mentioned that Medicare Advantage Plans have networks that can change from year to year, as well as other disadvantages. This is not true for our Medicare Advantage HMO, according to my experience. The HMO has its own doctors and hospitals, but I have not noticed them pulling any surprises. And they do look after your health much better than the traditional Medicare that some of my friends are on. My friends’ care is entirely in their own hands, and some are getting very old and would benefit from the care that my HMO provides.

Answer: You’ve highlighted one of the key advantages of a Medicare Advantage HMO, which is coordinated care.

There are two main types of Medicare Advantage plans, the all-in-one private insurance alternative to original Medicare. With PPOs — preferred provider organizations — people are generally allowed to see medical providers outside their networks, although those visits will cost more. With HMOs — health maintenance organizations — you’re expected to stay in the network for most care, and you often need a referral to see a specialist. You could pay up to 100% of the cost if you use a doctor or hospital not in the HMO.

In exchange for those restrictions, people get a primary care provider who coordinates all of their care. That’s in contrast to PPOs or original Medicare, where a patient may have many providers who never talk to each other.

Filed Under: Medicare, Q&A Tagged With: HMO, Medicare, Medicare Advantage, Medicare Advantage plan, Medicare Advantage plans, PPO

Q&A: Medicare Advantage to Original Medicare

January 27, 2025 By Liz Weston

Dear Liz: I just read your answer about switching from Medicare Advantage plans to original Medicare, and how you might not be able to get an insurer to write you a supplemental Medigap plan. I was with a Medicare Advantage plan for years and then my medical group stopped participating. I have many preexisting conditions and would not be able to find adequate or affordable coverage if I had to apply for a supplemental plan. Luckily another insurer gave automatic acceptance to the 32,000 of us who were thrown out of our medical group so I was able to get full coverage through a Medicare supplement.

I hope you will repeat this info in several columns so consumers are better informed. I had no idea you couldn’t easily switch back and forth.

Answer: To recap, Medicare Advantage is the private insurance alternative to original Medicare. Like other private coverage, Medicare Advantage plans have networks and benefits that can change from year to year. Original Medicare benefits typically don’t change, but many expenses aren’t covered so you generally need a private insurance supplement to pay for those costs.

If you want to switch from Medicare Advantage to original Medicare after the first year, however, you normally don’t have “guaranteed issue” rights for a Medigap supplemental policy and you could pay a lot more for this important additional coverage.

There is a “nuclear option” that would give you guaranteed-issue rights again, and that’s moving out of your Medicare Advantage plan’s coverage area. You have to actually move, not just temporarily relocate. But you would be able to switch to original Medicare and get a guaranteed-issue supplemental plan.

Filed Under: Medicare, Q&A Tagged With: Medicare, Medicare Advantage, Medicare Advantage plan, Medicare supplement insurance plans, Medicare supplemental plan, Medigap

This week’s money news

March 11, 2024 By Liz Weston

This week’s top story: When you want to leave your medicare advantage plan but feel stuck. In other news: How the SVB collapse still ripples through banking, 5 financial mistakes to avoid when you are self-employed, and what small-business owners need to know about NIL sponsorships.

When You Want to Leave Your Medicare Advantage Plan — But Feel Stuck
How to get out of your Medicare Advantage plan if it’s not right for you — and what to do if there are no good alternatives.

How the SVB Collapse Still Ripples Through Banking, 1 Year Later
Five banks failed last year, including Silicon Valley Bank. Keeping your money FDIC-insured goes a long way to prepare you for any future bank collapse.

5 Financial Mistakes to Avoid When You Are Self-Employed
Self-employment can be rewarding, but it can also be expensive when you make certain financial mistakes.

What Small-Business Owners Need to Know About NIL Sponsorships
Small-business owners can use name, image, likeness sponsorships, but should be intentional and avoid investing simply as fans.

Filed Under: Liz's Blog Tagged With: Medicare, Medicare Advantage plan, self-employment, Silicon Valley Bank, small business

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