California seniors with Medicare Advantage spend 30 percent fewer days in the hospital.
Medicare comes in four basic parts. Parts A and B were the original Medicare policies and have benefits mainly for hospital care and preventive services. Part D Medicare offers prescription drug coverage. Part C, Medicare Advantage, allows users to buy their Part A and B benefits from private insurance companies, which may offer extra benefits not included in original Medicare, such as vision and hearing. States regulate the sale of Medicare Advantage, and MA plans in California can be sold as several kinds of policies. One of the most popular is the PPO, preferred provider organization, policy.
Networks
Medicare Advantage PPO plans in California operate in a similar way to HMO, health maintenance organization, policies. Both have approved networks of health care providers, but with a PPO, you can go outside the network if you so choose. This will lead to higher co-payments on your part, but you do have the freedom to choose. With PPO plans, you also usually do not need a referral from your primary care physician before you can see a specialist.
Benefits
California's Medicare Advantage PPO plans are required to offer all the same benefits as Part A and B Medicare bought straight from the federal government. These include home health services, ambulance transportation, inpatient and outpatient hospital care, preventive screenings and programs such as diabetes self-management and smoking cessation therapy. Prescription drug coverage is generally included in Medicare Advantage PPOs at no extra cost, but you will need to pay co-pays for generic and name-brand medications. Medicare Advantage PPOs may also offer additional benefits, such as vision, dental and chiropractic.
Service Areas
Medicare Advantage plans are often sold according to service area, which means that if you move out of your plan's service area, you will need to buy a new plan. However, as of 2011, California had two regional PPO plans that were offered statewide. One, the Anthem Freedom Blue 1, features prescription drug benefits while the other, the Freedom Blue Classic, does not.
Costs
Medicare Advantage carriers in California are allowed to charge their own premiums, co-pays, co-insurance costs and deductibles. PPOs always have a deductible that must be reached before insurance begins to cover benefits, but this does not apply to certain services such as doctor's visits, which just require a co-payment. As of 2011, Medicare Advantage PPOs must set a mandatory out-of-pocket limit for users. In 2011, the maximum amount an insurance company could establish for this was $6,700, but a company can decide on a lower amount. Medicare Advantage plans also cannot charge more what original Medicare would charge for chemotherapy, kidney dialysis and stays in a skilled nursing facility.
Tags: Medicare Advantage, Advantage plans, Medicare Advantage plans, Advantage PPOs, Medicare Advantage PPOs
