HMO vs. PPO: Choose the One Plan that Meets Your Needs

SNP Benefits and Features SNPs offer several features that differentiate them from standard Medicare Advantage Plans: Customized Benefits: SNPs may include services like case management, disease-specific education, and access to specialists aligned with the member’s condition. Coordinated Care: Members are typically assigned a care coordinator to help manage treatments, medications, and appointments across multiple providers. Integrated Services: Especially in D-SNPs, plans often integrate Medicare and Medicaid services, which can simplify care in some areas. Prescription Drug Coverage: All SNPs must provide Medicare Part D coverage with formularies designed to meet the medical needs of their member population. When is Enrollment for an SNP? Enrollment in an SNP can occur during standard Medicare enrollment periods:  Initial Enrollment Period (IEP) Annual Enrollment Period (AEP): October 15 to December 7 each year Open Enrollment Period (OEP): January 1 to March 31 (for those already enrolled in a Medicare Advantage plan) Special Enrollment Periods (SEPs) may also apply. For example, individuals who newly qualify for Medicaid or are diagnosed with a chronic condition that makes them eligible for a C-SNP may be able to join an SNP outside of the standard periods. Not all SNPs are available in every region. Plan offerings vary by county and state, and each plan has its own list of covered services and provider networks. It is important to compare available plans to determine whether a specific SNP meets your healthcare needs and eligibility. Contact one of our licensed insurance agents today for more information about SNPs or to see if a SNP could benefit you or any questions regarding Medicare Advantage Plans. We do not offer every plan available in your area. Currently, we represent 7 organizations that offer 58 products in your area. Please contact Medicare.gov , 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options. Not connected with or endorsed by the U.S. government or the federal Medicare program.

When considering a Medicare Advantage (MA) plan, one of the most important factors to evaluate is the network type . Your Medicare Advantage network type determines which doctors, hospitals, and specialists you’ll be able to visit— and how much you’ll pay for healthcare services. In order to choose the right plan, you’ll need to understand how these networks operate, what their benefits are, and any limitations. Understanding Medicare Advantage Network Types While you can always reach out to one of our insurance experts for help navigating Medicare Advantage Networks, here’s a basic breakdown of the various Medicare Advantage network types. 1. Health Maintenance Organization (HMO) Plans HMO plans are among the most common Medicare Advantage plans. They emphasize cost control and coordination of care. Key Features: Network Restrictions: You must use healthcare providers within the plan’s network except for emergencies. Primary Care Physician (PCP) Requirement: Most HMO plans require you to select a PCP who will coordinate your care. Referrals Needed: If you need to see a specialist, your PCP must provide a referral. Lower Costs: Since care is coordinated and limited to a specific network, HMOs typically have lower premiums and out-of-pocket costs. Who Should Consider an HMO? Individuals who don’t mind having a PCP manage their healthcare. Those looking for lower costs and predictable copayments. People who are comfortable sticking to a specific network of providers. 2. Preferred Provider Organization (PPO) Plans PPO plans offer more flexibility in choosing healthcare providers compared to HMOs. Key Features: Flexible Network Options: You can see both in-network and out-of-network providers, though out-of-network care costs more. No PCP Requirement: You don’t need to designate a primary care physician. No Referrals Needed: You can visit specialists without a referral. Higher Costs: Monthly premiums and out-of-pocket costs tend to be higher than those of HMO plans. Who Should Consider a PPO? Those who want the freedom to see any doctor or specialist without referrals. Individuals who travel frequently or live in multiple states. People who are willing to pay more for flexibility in choosing providers. 3. Private Fee-for-Service (PFFS) Plans PFFS plans offer greater provider flexibility, but they operate differently from HMOs and PPOs. Key Features: No Network Restrictions (Sometimes): Some PFFS plans allow you to see any provider who accepts the plan’s terms, while others have networks. No PCP or Referral Requirements: You can see specialists directly without needing a referral. Provider Participation May Vary: Healthcare providers can choose on a case-by-case basis whether to accept the plan’s payment terms. Who Should Consider a PFFS? Individuals who want flexibility but don’t mind confirming provider acceptance before each visit. Those living in areas with limited HMO or PPO options. People who prefer not having to coordinate care through a PCP. 4. Special Needs Plans (SNPs) SNPs are tailored to individuals with specific health conditions, financial situations, or institutional care needs. Key Features: Targeted Care Coordination: These plans are designed for specific groups, such as individuals with chronic illnesses, those eligible for both Medicare and Medicaid, or those living in nursing homes. Network Restrictions: Most SNPs function like HMOs, requiring members to stay within a network. Specialized Services: Plans may offer extra benefits tailored to the enrollee’s health condition. Who Should Consider an SNP? Individuals with chronic diseases (such as diabetes or heart disease). Those eligible for both Medicare and Medicaid. People who require institutional care (such as nursing home residents). 5. Medicare Medical Savings Account (MSA) Plans MSA plans combine a high-deductible health plan with a savings account that can be used for medical expenses. Key Features: No Network Restrictions: You can see any Medicare-approved provider. Savings Account for Healthcare Costs: Medicare deposits money into your account to help pay for out-of-pocket medical expenses. High Deductible: You must pay for medical services out-of-pocket until you reach the plan’s high deductible. Who Should Consider an MSA? Individuals who want full control over their healthcare spending. Those comfortable managing a high-deductible plan. People looking for a tax-advantaged way to save for medical expenses. How to Choose the Right Medicare Advantage Network Type Selecting the best Medicare Advantage network type depends on several factors: Budget: If you want lower premiums and predictable costs, an HMO may be the best choice. If you’re willing to pay higher premiums for flexibility, a PPO could be better. Provider Access: If you have preferred doctors or specialists you don’t want to switch from, check if they’re in-network for an HMO or covered at a reasonable cost under a PPO. Health Conditions: If you have chronic conditions, an SNP may provide specialized care that fits your needs. Flexibility Needs: If you travel often or need nationwide coverage, a PPO, PFFS, or MSA plan may be a better fit. If you want to get the most out of your health care coverage, minimize costs, and find the right health coverage for your unique circumstances, you must understand the difference between Medicare Advantage network types. Whether you prioritize cost savings, flexibility, or specialized care, there’s an option that fits your needs. Before enrolling, compare plans carefully, check provider networks, and consider how each network type aligns with your healthcare preferences. Taking the time to choose the right Medicare Advantage plan will help ensure you get the best possible care at the most affordable cost. Contact us today for help navigating Medicare Advantage plans. We’re here to answer all of your Medicare questions!

Learning how to navigate urgent health care coverage with Medicare Advantage Plans is invaluable. Healthcare emergencies are almost always unexpected. Having a clear understanding of your coverage is critical, and can provide much-needed peace of mind. If you are enrolled in a Medicare Advantage plan, knowing how these plans handle emergency and urgent care is essential— especially if you travel frequently or are considering international travel. Here’s what you should know: What Is Medicare Advantage? Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. These plans provide the same benefits as Medicare (Parts A and B) and often include additional services such as dental, vision, hearing, and prescription drug coverage. While these plans aim to provide comprehensive coverage, the rules surrounding emergency and urgent care can differ from Medicare. Emergency Care Coverage with Medicare Advantage Medicare Advantage plans are legally required to cover emergency care services, regardless of whether the provider is in or out of the plan’s network. Here’s the breakdown: No Prior Authorization Needed: For true emergencies—such as heart attacks, strokes, or severe injuries—Medicare Advantage plans cannot require prior authorization for coverage. Coverage Anywhere in the US: Your Medicare Advantage must offer emergency services anywhere in the country, whether you’re at home or traveling. However, care may be limited to in-network providers unless otherwise authorized. Our insurance experts can help you understand what your coverage includes. Ambulance Services: Emergency ambulance transportation is typically covered. Speak with one of our insurance experts today to understand any exceptions your plan may outline. Urgent Care with Medicare Advantage Medicare Advantage plans cover most urgent care services, including services from out-of-network providers. If you do seek urgent care out-of-network, coverage will still apply, though you might pay higher out-of-pocket costs than you would with in-network providers. Keep in mind that some plans may have restrictions on follow-up care or may require you to return to an in-network provider for additional treatment. International Travel Coverage Medicare Advantage plan coverage can vary significantly for services performed outside the United States. Medicare does not generally cover international healthcare services, but many Medicare Advantage plans include limited coverage for emergencies during international travel. International travel coverage with Medicare Advantage typically includes hospital visits, urgent care, and emergency transportation. Your coverage limits and reimbursement policies vary, so it’s essential to understand the specifics of your plan. Keep in Mind: Many plans offer additional travel assistance programs that can help coordinate care during international emergencies. If your plan has limited international coverage, you may consider supplementing your coverage options by purchasing a travel health insurance policy or a Medigap plan with foreign travel benefits for added peace of mind. There are several steps you should take before traveling internationally. Review Your Plan Details: Contact one of our Medicare Advantage experts to go over a detailed explanation of your plan’s international coverage. Emergency and urgent care services may involve copayments or coinsurance, which could vary depending on the care location. Understand Your Plan’s Network Rules: While emergencies are covered anywhere, non-emergency follow-up care often requires you to use in-network providers. Understand what qualifies as in-network to avoid additional costs down the road. Plan for Out-of-Pocket Costs: Be prepared to pay for care upfront in some countries, as many international healthcare providers may not bill your insurance directly. Carry Documentation: Always have a copy of your insurance card and contact information for your insurance provider readily available. Stay Prepared When Traveling: Both domestic and international travelers should confirm their coverage and make contingency plans for unexpected medical needs. Be Prepared When emergencies strike, having the right knowledge can make all the difference. Medicare Advantage plans provide comprehensive coverage, but the specifics of emergency and urgent care can vary. Whether you’re managing a health crisis at home or traveling internationally, taking the time to understand your plan’s benefits ensures you’re prepared for the unexpected. Reach out to one of our experts today to clarify any uncertainties and ensure your healthcare coverage aligns with your lifestyle and travel needs.

With rising healthcare costs, many Medicare Advantage members are noticing increasing out-of-pocket expenses. As co-pays rise due to the Inflation Reduction Act and reduced funding for Medicare Advantage plans, it’s more important than ever to explore ways to protect yourself from unexpected medical costs. One option to consider is adding a Hospital Indemnity plan to your healthcare coverage. But is it worth it? Medicare Advantage and Rising Co-Pays Medicare Advantage, also known as Part C , has historically been an attractive option due to its low premiums and added benefits compared to traditional Medicare. These plans often cover prescription drugs, dental, vision, and hearing services, which Original Medicare does not. With recent changes, members are seeing an increase in co-pays for services such as hospital stays, specialist visits, and outpatient care. This is largely due to shifts in funding and rising healthcare costs across the board. While Medicare Advantage still offers good value, especially when compared to standalone Medicare, higher out-of-pocket expenses can catch many beneficiaries off guard—particularly in the case of an unexpected hospital stay. That’s where Hospital Indemnity insurance comes in. What is Hospital Indemnity Insurance? Hospital Indemnity insurance is a supplemental plan designed to provide financial protection for hospital-related expenses not fully covered by your Medicare Advantage plan. If you’re admitted to the hospital, this insurance pays a set amount for each day you spend in the hospital, depending on your plan’s coverage. It can also cover other associated costs like ambulance rides or extended hospital stays. The benefit of Hospital Indemnity insurance is that it provides cash payouts directly to you, which you can use to pay for any expenses—whether it’s hospital co-pays, deductibles, or other unexpected costs you incur during your recovery. Is It Worth It? As healthcare costs continue to rise, having an extra layer of financial protection can be invaluable. Hospital stays can lead to significant out-of-pocket costs under a Medicare Advantage plan, and a Hospital Indemnity policy helps mitigate those expenses. While it does add an additional monthly premium, it can provide peace of mind, ensuring that an unexpected medical emergency doesn’t turn into a financial burden. For many, the protection offered by Hospital Indemnity insurance makes it a worthwhile investment in a time of rising healthcare costs. If you need help weighing your options or are considering a Hospital Indemnity policy, contact one of our expert agents today . We’re here to help!

Questions About the New Medicare Part D Benefit Redesign? Medicare Part D has seen several changes this year, and it’s important to stay informed to ensure you’re maximizing your benefits and managing your prescription drug costs effectively. Here are the key updates to be aware of: 1. Deductible Increase The Part D deductible has increased to $590 for some plans in 2024. This means that you will need to pay out-of-pocket for your prescription medications until you meet the deductible amount before your plan begins sharing the cost. It’s a higher initial expense, so it’s important to plan for this increase when budgeting for your healthcare needs. 2. New Manufacturer Discount Program A new Medicare Manufacturer Discount Program has been introduced, which may provide better savings for some prescription drugs. However, it’s crucial to avoid using your manufacturer’s discount card for the same medication, as this may disqualify you from receiving the Medicare discount. If you’re unsure whether this applies to your medication, talk to your pharmacist or one of our agents to make sure you’re getting the best possible savings. 3. Medicare Prescription Payment Plan For beneficiaries who find it difficult to cover high medication costs upfront, Medicare now offers a Prescription Payment Plan. This allows you to spread out your payments over time rather than paying the full cost all at once. To enroll in this program, speak with your pharmacy or contact your plan’s member services department to see if this option can help manage your out-of-pocket expenses. You can always speak with one of our agents if you have additional questions. 4. Check Your Drug Coverage Not all prescription drugs are covered by every Medicare Part D plan . Each plan has a formulary, which is a list of covered medications. It’s important to review this list to ensure your medications are included. If your prescription isn’t covered, you could end up paying much more out-of-pocket, or you may need to explore alternative medications or plans. 5. Should you consider Medicare Advantage? With rising costs, you might be considering switching to a different Part D plan . During the Annual Enrollment Period, people can enroll into a Medicare Advantage with Part D. These plans could provide better coverage for your prescriptions and lower overall costs in the long run. Be sure to weigh the upfront premium cost against potential savings on your medications. Consulting a Medicare expert can help you decide if switching to a Medicare Advantage plan will offer you more value based on your specific needs. Be sure to review your current plan and consider all available options so you get the most cost-effective coverage for your medications in 2024. Our experienced agents can help you through the entire process. Give us a call today!

Checklist for 2025 Medicare Annual Enrollment Period  It’s important to review your Medicare coverage every year before Medicare Annual Enrollment begins. If you’re a senior preparing for open enrollment, this simple checklist can guide you as you prepare to review your plan options. Look for Your Annual Notice of Changes (ANOC) Medicare plans often change from year to year. Your current plan will send an Annual Notice of Changes (ANOC), which explains updates to costs, coverage, and benefits. Review this carefully, as these changes may impact your healthcare needs in 2025. If you don’t receive this notice, contact your plan directly. Know the Timeframes October 1st : Medicare plan information for 2025 becomes available. This is when you can begin reviewing the different plans and comparing their benefits. October 15th : The official start of the Annual Enrollment Period. From this date, you can change your Medicare plan, switch from Original Medicare to Medicare Advantage, or adjust your Part D (prescription drug) coverage. December 7th : The last day to make changes for the upcoming year. After this date, you’ll be locked into your plan for 2025 unless you qualify for a Special Enrollment Period. Get Your Prescription List Ready Many plans offer different coverage for prescription drugs, so it’s essential to have an up-to-date list of all your medications. Our office can assist you with an easy-to-complete electronic questionnaire or help you over the phone. By having your medication list ready, you’ll be better prepared to find a plan that covers your needs.By having your medication list ready, you’ll be better prepared to find a plan that covers your needs. Check Your Doctors and Providers If you’re considering switching plans, confirm that your doctors, specialists, and other healthcare providers are included in the plan’s network. In-network providers typically mean lower costs for services, so it’s crucial to ensure your trusted providers are covered under any new plan you choose. Expect Changes in 2025 Medicare costs can fluctuate each year. Premiums, deductibles, and out-of-pocket costs may increase in 2025. While some benefits may improve, it’s important to be aware of potential cost increases so you can plan accordingly. Develop a Budget With potential increasing cost & inflation, it’s wise to create a healthcare budget for 2025. Include premiums, copayments, medications, and any other out-of-pocket expenses. If you’re unsure how to budget for healthcare, our team can help you review your plan options and develop a financial plan that fits your needs. For more help, contact one of our agents at Choice City Health. We’re here to make the process as smooth as possible!

2025 Medicare Part D Changes If you’re eligible for Medicare, then having Medicare Part D has been an important aspect of your coverage and you should know about the changes taking place as a result of the Inflation Reduction Act from 2022. Here’s what changes are coming in 2025 and some tips for navigating the upcoming Annual Enrollment Period. 2025 Changes Include: New Part D design – With this new structure the “donut-hole” coverage gap is going away! You’ll pay 100% of your deductible. After you’ve met your deductible you’ll pay 25% of the cost of your drugs until you reach the out-of-pocket maximum. After that, you’ll pay nothing! Lower Max Out of Pocket – The maximum out-of-pocket cost that you’ll pay for your prescriptions each year is now $2,000. Part D Manufacturer discount – Members with limited income who qualify for “Extra Help” will get an even bigger discount on their prescription drugs. You can talk to an agent about if you qualify for extra help . Prescription Drug Payment Plan – All Medicare prescription plans must offer a monthly payment plan. This is a program you can opt into at any time. It’s designed to help smooth out your prescription cost during the calendar year by spreading out the cost of more expensive prescriptions. What to expect when choosing a Part D Plan for 2025: Starting in 2025, after you’ve paid your $2,000 deductible, insurance companies and drug manufacturers will pick up the majority of the tab. This could have an impact on your formulary and list of covered prescriptions. Other factors to consider: Pharmacy Networks – The new payment plan could impact some consumers’ preferred pharmacies. Plan Ratings & Reviews – Look carefully at The Star Ratings systems to compare which prescription drug plan may be right for you. An agent can help you understand the differences and see which coverage will be right for you, especially with next year’s changes. Evaluate the cost & coverage – When choosing the right plan, be sure to consider these factors: Premiums Annual deductibles Do you only take generics? While Medicare coverage can seem overwhelming and the annual enrollment period can feel daunting, our agents are here to help. Consult with a Licensed Insurance Broker to get all your coverage questions answered. Schedule a free call today!

So, you’re turning 65 soon. You’ve come a long way in life and have gained valuable wisdom and experiences in life. However, making decisions about Medicare may not seem straightforward- with all the choices, getting set up can be a bit intimidating. That is where having a local insurance agent can be valuable. Here at Choice City Health, we have made a full-time job of working with folks either turning 65 or preparing to retire and start Medicare. We’ve created a simple-to-understand Medicare checklist for turning 65 for those who are new to Medicare As a reminder, Medicare is a federal health insurance program that provides benefits for those older than 65, under age 65 with certain disabilities, and people of all ages with end-stage renal disease (ESRD), permanent kidney failure requiring dialysis, or a kidney transplant. There are four parts to Medicare coverage: A, B, C and D (learn more about this here ). We suggest that you start considering the following information 6 months prior to turning 65 so that you do not miss any deadlines that could cause increased costs and other consequences moving forward. Medicare Checklist #1: Insurance Prior to 65 Depending on if and/or what type of health insurance you’re enrolled in before turning 65, your deadline to sign up for Medicare will differ. For example, if you are drawing your Social Security benefits before 65, you will automatically be enrolled in Medicare part A and B. However, you have the right to turn down part B if you do not want it, and that could save you a lot of money if you don’t need it. If you aren’t collecting Social Security by 65 or you’re using your company’s insurance, then it’s up to you to manually sign up for Medicare. The Federal Government will not alert you of any deadlines and missing one could lead to higher premiums and even declined coverage based on your health. Our team of insurance advisors can help you with your Medicare checklist and understanding all the options and deadlines you need to know so that you can make the right choice for you without being penalized. #2: Learn Your Deadlines Over 760,000 Medicare enrollees are paying enrollment penalties – don’t let yourself be added to the list. These penalties don’t go away, but can be avoided by meeting deadlines. Don’t be hard on yourself for not knowing deadlines – you’re not alone. If you’re not collecting Social Security before 65, the government won’t notify you regarding the deadlines (as of 2016, 40% of citizens aren’t claiming SS by 65). Researching deadlines or meeting with a professional Medicare advisor is key for your Medicare checklist for turning 65 if you want to avoid irreversible penalties. #3: Understand Your Options Medicare has four parts: A, B, C, and D. They all involve different things: hospital care, medical care, Medicare Advantage, and drug coverage. If you start collecting early social security retirement while you’re working and have employer coverage, you may be automatically enrolled in part B without necessarily needing it or if you’re on an employer plan and miss a deadline to sign up for part C or D. Understanding all your options and what they entail will help you make the best-educated decision for your lifestyle (and wallet). Putting this off could lead to unnecessary stress and costs that you’ll carry with you. We hope that this Medicare checklist is a helpful guide to get you started. Meeting with a Medicare Advisor will ensure that you are prepared, relaxed, and confident when it comes time for you to sign up. Choice City Health doesn’t charge any fees and is paid directly by the insurance carriers we represent. Our mission is to help you have a seamless experience that will give you all the tools and support a smooth transition into Medicare. #4: Refer to Our Medicare Checklist Use Choice City Health’s actionable checklist below to make sure that your transition into Medicare is as stress-free as possible. The key is being prepared – you got this! If you have any questions or are looking to make the most confident choice in your plan, contact us at 970-407-9399 today for a free consultation. We look forward to meeting you. 7-10 months before your 65th birthday: Review your current health plan Visit the Social Security Administration website (or call) to confirm your eligibility 4-6 months before your 65th birthday: Check with your health providers to see if they accept medicare Meet with a professional Medicare advisor to help you fully understand all of your options and decide on a plan that works best for you Get cost estimates for part B Get quotes for Medicare supplement insurance and learn about Medicare Advantage Understand the enrollment periods to avoid pen alties 3 months before your 65th birthday: Continue to utilize your Medicare advisor as a resource to answer questions Enroll in Medicare part A. If you’re claiming Social Security, you should get your Medicare card in the mail Decide if you want to enroll in part B and/or C & D Sit back, relax, and enjoy your benefits knowing that you have made the right choice.