Medicare Advantage Plans

• Help pay for hospital costs, doctor’s visits, and other medical services
• May also include built-in Medicare prescription drug coverage (Part D) often at no additional premium
• Have an out-of-pocket maximum that helps limit health care expenses
• Typically provide additional benefits, like health and wellness benefits, that Original Medicare doesn’t cover
• Have plan premiums not based on age or health (except for End Stage Renal Disease)
• Combine all benefits and services in one plan
• Come in several different forms:
  • Health Maintenance Organizations (HMOs)
  • Preferred Provider Organizations (PPOs)
  • Point of Service (POS)
  • Private-Fee-For-Service (PFFS)

HMO Plans

• Feature single card convenience
• Include plans starting at $0 monthly plan premiums
• Provide additional benefits and services not covered by Original Medicare
• Often include Medicare prescription drug coverage (Part D)
• Provide access to a local contracted network of doctors
• Require a referral to see a specialist, in some plans

 

 

AARP Medicare Complete Secure Horizons Essential (HMO)

• $0 monthly health plan premium for those who want medical benefits but do not require drug coverage
• Gym membership including fitness classes offered through Silver Sneakers® at no additional cost
• Chiropractic and acupuncture benefits
• Enhanced vision and hearing benefits
• A company you can depend on
• Worldwide emergency care coverage

Benefits at a Glance    

Provider Directory - English    

EOC    

Evergreen Health Innovations Flyer      

Silver Sneakers Base plans      

Dental High Option/Optional Rider       

Pre-Enrollment Booklet    

 

PPO Plans

PPO plans offer the benefits of an HMO plan as well as these additional key features:

• Freedom to receive care from provider of choice, inside or outside the network
• No provider referrals are ever needed
• Allows your client to maximize their benefit when they receive care inside the plan’s network of providers. Going outside the network for covered services generally costs more money.

POS Plans are HMO plans that also offer members the ability to:

POS Plans

Point of Service Plans are like HMO plans, but they also offer members the ability to:

• Visit doctors outside their network, typically for a higher co-payment/coinsurance
• Access providers without referrals, in many plans

Special Needs Plans

Special Needs Plans have three basic types of plans designed for individuals in the following situations:

• People eligible for both Medicare and Medicaid (state medical assistance)
• People living in nursing homes, long-term care or assisted living facilities
• People who have one or more chronic conditions like Diabetes Mellitus, Chronic Heart Failure, Cardiac Arrhythmia, Peripheral Vascular Disease, Coronary Artery Disease (CAD), or Chronic Venous Thromboembolic Disorder

Here’s what Special Needs Plans can do for your client:

• Help pay for hospital costs, doctor’s visits, and other medical services (Medicare Parts A & B)
• Include built-in prescription drug coverage (Part D), often at no additional premium
• Provide additional benefits like health and wellness benefits, that Original Medicare doesn’t cover
• Combine hospital, medical care, and prescription drug coverage into one plan

PFFS Plans

A Private-Fee-For-Service (PFFS) Plan offers the ability to control out of pocket expenses while providing the flexibility of provider selection. Here are some advantages of a PFFS Plan:

• Freedom to see any doctors and hospitals that agree to accept the plan’s terms and conditions each time your client seeks services
• Provides benefits that Original Medicare doesn’t cover
• Helps limit out-of-pocket expenses for covered services

Medicare Part D Plans

Medicare Part D Plans help cover the cost of your client’s prescription drugs. Here are some of the main features of a Part D plan:

• Provide help with the cost of prescription medications
• Are only offered through private insurance companies
• Are usually offered two ways:
  • As a standalone plan to add coverage to Original Medicare Parts A and B and to complement a Medicare Supplement plan
  • As part of a Medicare Advantage (Part C) Plan
  • Have a specific list of approved drugs they cover (called a formulary or drug list)

Medicare Supplement Plans

A Medicare Supplement plan (also known as “Medigap”) provides additional coverage beyond Original Medicare.

Here are the main features these plans offer:

• Help reduce or eliminate money paid out of pocket for care received (deductibles, co-pays, and coinsurance)
• Standardized plans that are identified by letters - A through N (Massachusetts, Minnesota and Wisconsin have their own standardized plans)
• Are only offered through private insurance companies

What these plans can do for your clients:

• Help manage out-of-pocket costs
• Give freedom to choose any doctor that accepts Medicare patients and see a specialist without a referral
• Minimal paperwork with virtually no claim forms to file
• Provide national coverage so your client can use benefits anywhere in the U.S. and if they move, their coverage moves with them
• Some plans provide foreign travel coverage for emergency services
• Provide guaranteed renewable coverage, meaning the plan automatically renews or is guaranteed to continue from year to year as long as premiums are paid when due
• Provide a 30-day “free look” evaluation period. Full refund of premiums if policy is returned within 30 days of policy issuance.
• Offer special extras such as pharmacy savings, vision discounts, and a 24-hour Nurse Hotline, depending on the plan.