ARE ANY MEDICARE MANAGED CARE PLANS AVAILABLE WHERE I LIVE?

Currently, you can choose from three types of Medicare Managed Care:
  • Cost Contract HMO
  • Medicare Advantage PPO
  • Medicare Advantage PFFS

These plans are available in selected counties of Indiana and it is important to know the differences between them.

COST CONTRACT HMO
Medicare will reimburse the plan for covered services you receive. You choose a primary care provider within the HMO network. When you stay within the network, you pay nothing except the plan premium and any small copayment amounts preset by the HMO.

You may also choose to use services outside of the network. When you choose to use a service or provider outside the Cost Contract HMO network, Medicare would still pay their usual share of the approved amount. You would be responsible for the Medicare deductibles and copayments. The Cost Contract HMO would not pay these. Cost Contract HMOs may enroll you if you don't have Medicare Part A but have and pay for Medicare Part B. Cost Contract HMOs do not have to enroll you if you have end-stage kidney disease or are already enrolled in the Medicare hospice program.

MEDICARE ADVANTAGE PPO
This type of managed care plan maintains a list of preferred providers but lets you see doctors and hospitals outside the plan for an additional cost. If you choose to use a provider outside of the network, the plan will pay the same reimbursements as Original Medicare will unless you need emergency or urgent care.

You will be responsible for the Medicare deductibles and co-insurance. Usually with a preferred provider organization you are not required to have a primary care physician and do not need a referral to see a doctor outside the plan. You must have both Medicare Part A and B.

MEDICARE ADVANTAGE PFFS
 If you enroll in a private fee-for-service, you can receive care from any Medicare doctor that agrees to the plan's terms, but you must live in the plan's service area to be eligible. Medicare pays the plan a set amount every month for each beneficiary enrolled in the plan. The plan pays providers on a fee-for-service basis. The plan charges enrollees a premium and cost-sharing amounts.

The PFFS plan offers the same benefits covered under Original Medicare and may provide extra benefits, but you have to pay more for any extra benefits. In most cases, beneficiaries enrolled in the private fee-for-service plan will pay less to see a doctor than under original fee-for-service.

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