Medicare Advantage Coordinated Care Plans

In this article...
  • Medicare Advantage plans often provide broader coverage than Original Medicare. Learn about the four types of Medicare Advantage coordinated care plans.

Medicare Advantage plans, often called Medicare Part C, offer the same coverage as Medicare Parts A and B. You can purchase a Medicare Advantage plan from a CMS-approved private provider, and most policies include prescription drug coverage and additional benefits unavailable through Original Medicare. 

If you're thinking about purchasing a Medicare Advantage policy, it's worth considering a Medicare Advantage coordinated care plan. Below, you can find out what these plans are and what they include. 

What Are Medicare Advantage Coordinated Care Plans?

Medicare Advantage coordinated care plans are the most common type of Medicare Advantage coverage. Each plan covers care from a network of approved providers, which usually results in lower out-of-pocket costs than you would otherwise pay. In addition, coordinated care plans cover the same services as regular Medicare. 

Depending on which plan you choose, you may be able to claim treatment from an out-of-network provider. However, this is usually more expensive than using an in-network provider. Many plans include additional coverage, such as prescription medication and dental care. 

Types of Medicare Advantage Coordinated Care Plans

There are four main types of Medicare Advantage coordinated care plans. Which type you should choose depends on several factors, including your health status, budget and coverage requirements. 

Health Maintenance Organization (HMO)

Medicare Advantage HMO policies are the most affordable coordinated care plans, generally charging lower premiums and out-of-pocket contributions. Most plans come with Medicare Part D prescription drug coverage.

However, you'll typically have to use an in-network provider if you want your policy to cover your medical costs. Many HMO plans require beneficiaries to pay most or all of their medical fees when they use an out-of-network clinic, except for emergency or urgent care and dialysis if you're away from home. Generally, HMO beneficiaries must nominate a primary care doctor, and your doctor must usually refer you for specialist treatment. 

Preferred Provider Organization (PPO)

Medicare Advantage PPO plans typically come with higher premiums and out-of-pocket costs because they cover treatment from out-of-network providers. However, it's often cheaper to select an in-network clinic. You can generally see a specialist healthcare provider without a referral, and many plans don't require beneficiaries to choose a primary care physician. Most Medicare Advantage PPO policies include Medicare Part D.

Special Needs Plans (SNPs)

A Medicare Advantage SNP may be a good option if you have a chronic health condition or you're also eligible for Medicaid. An SNP may also be suitable if you live in a residential care home. Not everyone is eligible for an SNP, and availability varies by area. 

All SNP beneficiaries must nominate a primary care doctor. You'll usually need to ask your doctor to refer you if you need to see a specialist. 

SNPs provide the same coverage as Original Medicare and must come with Medicare Part D. Some providers offer additional benefits, such as vision care. 

Point of Service (POS)

POS plans are an optional add-on policy to some HMO plans, sometimes called HMO-POS. You must choose a primary care doctor when you enroll on a POS plan, but your policy will also cover treatment from out-of-network providers. However, using an out-of-network clinic generally costs more out-of-pocket. Some providers cap the amount you can claim for out-of-network treatment or limit coverage to particular services. 

Some POS providers cover specialist treatment without a referral, and others require a referral from your designated primary care physician. POS policies usually come with Medicare Part D. 

What Is a Local CCP Plan in Medicare?

A local CCP plan is a type of PPO that only covers care received in certain areas. The provider sets the designated area with approval from the Centers for Medicare and Medicaid Services (CMS). The area may cover a single county or span several. 

Regional PPOs cover one or more states, and enrollees are entitled to uniform coverage wherever they receive care within the plan area. You may require a regional PPO if you live in a rural area and have to travel outside your locality to receive treatment. 

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