LUMBERTON
— Medicare open enrollment for coverage in 2020 begins Oct. 15 and runs through
Dec. 7.
During
this time, patients can switch from Original Medicare to Medicare Advantage.
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are a type
of Medicare health plan offered by private companies that contract with
Medicare. Medicare Advantage Plans provide all of a patient’s Part A and Part B
benefits. Most MA Plans offer prescription drug coverage, “Part D.”
Patients
can join a Medicare Advantage Plan if they live in the service area of the plan
they wish to join, if they already have Medicare Part A and Part B, and if they
don’t already have end-stage renal disease. Patients who join MA Plans are
still in the Medicare Program with all of its rights and protections.
There are
five types of MA Plans:
— HMO
(Health Maintenance Organization Plan): Allows patients to see doctors,
hospitals and other health professionals that participate in its network. If a
patient sees a provider that is not in the network, the plan may not pay those
health care costs, except for emergency care, out of area urgent care, or out
of area dialysis. In most cases, HMOs require patients to pick a primary care
physician, and they need a referral to see a specialist in most cases.
— PPO
(Preferred Provider Organization Plan): PPO plans offer coverage through a
network of providers, but patients are allowed to access out-of-network care
for covered services, usually for a high cost. If patients go to doctors and
hospitals in the plan’s network, they will generally pay less. Patients do not
need to choose a primary care doctor with a PPO, and usually do not need a
referral to see a specialist.
— PFFS
(Private Fee for Service): With PFFS plans, patients may go to any Medicare
approved doctor or hospital that has accepted the plans’ payment terms and
agreed to treat members of their plan. Patients will be treated in an emergency
even if the provider has not agreed to their plan’s terms. Patients do not need
to choose a primary care doctor with PFFS plans, and do not need a referral to
see a specialist.
— SNP
(Special Needs Plans): SNPs are only available to Medicare beneficiaries with
specific diseases, health conditions or financial circumstances. The plans are
structured to benefit their members according to their health needs. With an
SNP, patients need to visit in-network doctors and hospitals, unless they need
emergency or urgent care or in other limited situations. The plans usually
require that patients have a primary care doctor or a care coordinator. In
addition, patients usually need a referral to see a specialist.
— MSA
(Medical Savings Accounts): Medical Savings Accounts provide patients with a
high deductible health care plan and a bank account. Medicare will deposit
money into the account and patients can use the money to pay for their health
care services throughout the year. The money is tax-free as long as patients
use it on IRS-qualified medical expenses, which includes the health plan’s
deductible.
Southeastern
Health participates in the following four plans: Blue Cross and Blue Shield of
North Carolina, Clear Spring Health, Troy Advantage and Aetna. More information
will be forthcoming on the specifics of these plans as open enrollment
approaches.
For more
information on Medicare and Medicare Advantage Plans, please visit www.medicare.gov.
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