Senior Citizens age 65 years and older who are eligible for Medicare health insurance coverage have several choices in how they receive their Medicare benefits. These choices include:
This is a fee-for-service plan which has two parts. Part A, which provides hospital benefits and Part B, which provides medical out patient benefits. You may obtain treatment from any provider you choose. However, if the provider is considered a non-participating provider of Medicare, then you may be responsible for some of your own billing as well as for a higher percentage of the cost of your care.
Medicare Advantage HMO
This option is made available through private health insurance companies. Mills-Peninsula Medical Group makes this plan available to you through our affiliation with Pacificare Secure Horizons and Health Net Seniority Plus. The HMO Medicare products combine both Part A and Part B, otherwise known as Part C, as well as your Part D (Prescription Drug Coverage). Your health care will be delivered through a designated network of providers (physicians, hospitals and ancillary facilities). You will be able to select a Primary Care Physician who will coordinate your care and obtain any necessary pre-authorizations. Medicare Advantage HMO plans usually carry a set co-payment for outpatient services and overall out-of-pocket costs may be lower with one of these plans.
Medicare Advantage PPO
With a Medicare Advantage PPO plan you may obtain treatment from any provider you choose. However, if the provider is not part of the particular PPO network, your out-of-pocket expenses will be far greater than if you were cared for by a participating provider. Medicare PPO plans may have an annual deductible, co-payments and or co-insurance amounts. The Medicare Advantage PPO plans are Part C plans which combine both Part A and Part B covereage as well as Part D benefits.
Medicare Private Fee For Service
This plan is neither a PPO, HMO or original Medicare. There is no specific network or preferred provider organizations for the PFFS (Private-Fee-For-Service) plans. These plans are offered by private health insurance companies who process and pay the claims. Not all physicians accept Medicare Fee For Service plans so patients need to be sure to present their identification cards each time they access health care services. Each provider can decide at each visit whether or not to accept the plan and agree to treat you. If you join a Medicare Private Fee For Service Plan, you will still have all of your rights and protections as you do under original Medicare except that you may have additional out-of-pocket expenses for services that the particular Private Fee For Service Plan deems as not medically necessary.
Medicare Part A
Medicare Part B
Medical outpatient benefits
Medicare Part C
Medicare Advantage HMO or PPO plans that provide Part A & B and Part D all in one policy.
Medicare Part D
Prescription Drug Coverage available through private companies that are approved by Medicare. Plans may vary in the type of coverage provided.
For more information regarding Medicare coverage and the various health plan options, please visit www.medicare.gov
For further information or assistance you may also contact the following:
|San Mateo HICAP office |
Last Reviewed: February 2008