Discuss the Different Types of Medicare Advantage Plans, the key Differences Between them, and why Such Differences Exist (Essay Sample)

Medicare Advantage Plans
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Introduction
Medicare Advantage Plans come in different plans, plan A, B, C and plan D. Most people do not understand what exactly is entailed in this coverage, hence a lot of confusion when deciding which one to go for. Medicare Advantage Plans, however, include special needs plan, Medicare Medical Savings Account Plan, Private Free-for-Service Plans, Preferred Provider Organizations and Health Maintenance Organizations. When enrolled to a Medicare Advantage Plan, the Medicare services will be covered through a plan and will not be required to be paid for under the Original Medicare.
Which are these types of Medicare advantage Plans
Health Maintenance Organization (HMO) Plans
The HMO plan requires you to visit healthcare providers and doctors that are listed in the plan. It is only in case of an emergency that you will be required to go to any hospital available, or closer to you. It is also important that you get a referral from your current primary care doctor. The HMO plans do cover for prescription drugs, in many cases. There is however an option for Medicare prescription drug coverage which you can join and will cover for drugs (Jacobson, (2015).
Preferred Provider Organization (PPO) Plans
This kind of Plan is offered by private insurance companies and it is known as Medicare Advantage Plan (Part C).If you decide to use healthcare providers, hospitals and doctors that are listed with the plan you will pay less. Going to hospitals and doctors outside the plans network individuals will be required to pay more. Prescription drugs are covered in a PPO Plan. You will have to join a PPO plan that caters for prescription drug coverage. You can’t join Medicare Prescription Drug Plan (Part D) if you do not join the one that does not cover for prescription drugs. You do not require a referral from your doctor in a PPO Plan to see a specialist. Use plan specialists as they are cheaper than non-plan specialists.
Private Fee-for-Service (PFFS) Plans
This Medicare Advantage Plan, (Part C), PFFS can only be offered by private insurance companies. Do not confuse this Medicare Advantage Plan with Medigap or Original Medicare they are not the same (Baylis, (2010). This plan determines the amount it pays to hospitals, healthcare providers, and doctors, and this will reflect on how much you will have to pay when you join this type of care.
You can go to any Medicare approved doctor or hospital, but it hast to accept the PFFS plans payment terms and must also accept to treat you. Not all the healthcare providers accept to this, so this should be noted. It is advisable to join a PFFS plan that has a network, this way you see all network providers who can treat patients in this plan. If you choose an out-of-network hospital or doctor that accepts the plan, you may end up paying more. Prescription drugs are sometimes covered by PPFS plans. No referrals nor is it necessary to choose a primary doctor in this plan.
Special Needs Plans (SNPs)
Medicare Special Needs plans are part of the Medicare Advantage Plans that is designed specifically for individuals with specific diseases or conditions. Depending on the groups they belong, the Plans are tailored to match their needs, drug formularies and provider choices. Except for urgent care and emergencies, a patient can get services and healthcare needs from a hospital or doctor who is in the SNP network. The SNPS Plan has specialist for all conditions and diseases for their patients. Medicare prescription coverage in all SNPs is available. A primary doctor in this plan is very vital and you will be required to have one, if not so you have to have a care coordinator who helps you with your healthcare. Referrals to see a specialist in this case are required; some cases are however exempted like screening mammograms, pelvic exams and pap tests which are done yearly.
Understanding the Plans and Choosing one that Best Suits an Individual
There are given rules for the Medicare Medical Advantage Plans, for instance it is Medicare that pays fixed amounts for your care, the company being paid needs to understand the rules and follow them to the latter.
Since the Plans are different you need to understand the reason for choosing a said plan. There are factors th...