A type of health insurance plan with which you can only go to the doctors and hospitals that have agreements with this plan. In case of emergency you can go to any health care service, even if it has no agreement with HMO plans. Your primary care doctor should give a referral before you see a specialist.
Types of Medicare Advantage Plans:
Also called Medigap and sold by private companies that can help pay some of the health care costs like copayments, coinsurance, and deductibles that Original Medicare doesn't cover.
Health Maintenance Organization (HMO) Plans
Proffered Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Medicare Advantage Plan which allows you to pay less if you use hospitals, doctors that belong to the network in that regional area. You pay additional cost if you use doctors and hospitals outside of the network.
Medicare Advantage Plan that allows you to go to any Medicare - approved doctor or hospital that agrees and accepts to treat you under the plan's payment terms. This is fee-for-service plan that decides how much you must pay for services.
Special Needs Plans (SNPs) Plans
Medicare Special Needs Plans are a type of Medicare Advantage Plan designed for certain types of people with Medicare. Some Special Needs Plans are for people with certain chronic diseases and conditions, some are for people who have both Medicare and Medicaid, and some are for people who live in an institution such as a nursing home.
HMO Point-of-Service (HMO-POS) Plans
These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.
What do Medicare Supplement Plans cover?
• Besides covering the healthcare costs like copayment, coinsurance and deductibles which are not covered by Original Medicare, some Medicare Supplement Plans (MS) also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S.
• If you have Original Medicare and you get Medicare Supplement Plan (Medigap), Medicare will pay its share of the Medicare-approved amount for covered health care costs, after that your MS (Medigap) plan pays its share.
Important Things to Know about Medicare Supplement Plans (Medigap):
• You must have Medicare Part A and Medicare Part B.
• A monthly premium paid to the private insurance company for Medicare Supplement Plan (Medigap) is separate from the monthly Part B premium that you pay to Medicare.
• If you have a Medicare Advantage Plan, you can apply for a Medicare Supplement Plan (Medigap), but make sure you can leave the Medicare Advantage Plan before your Medigap begins.
• A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
• You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.
• Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.
• Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
• It's illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.
The following Insurance plans are not Medicare Supplement Plans (Medigap):
• Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
• Medicare Prescription Drug Plans
• Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
• Veterans' benefits
• Long-term care insurance policies