Arizona Medicare Advantage Types and options
Ralph Bredahl is an Independent Medicare Broker in Sedona Arizona and is licensed in the state of Arizona. Medicare beneficiaries in Arizona have many choices when deciding on a Medicare Advantage plan and it can be a confusing choice. To enroll in an Arizona Medicare HMO you must have Medicare Part A and Medicare Part B, pay your Medicare Part B premium and live in the plans area (such as Maricopa or Pinal county in Arizona)
“As an Independent Medicare Broker in Arizona I have clients telling me that the task of choosing a plan for their needs is daunting” explained Ralph Bredahl, an independant broker with Arizona Medicare Advisors. HMO (Health Maintenance Organization), PPO (Preferred Provider Organizations), PFFS (Private Fee-for-Service). POS (Point of Service) and SNP (Special Needs Plans) are all Medicare Advantage options available to Medicare Beneficiaries in Arizona. There is no best plan or best type of plan since everyone has different needs. An overview of Medicare Advantage plans available in Arizona follows:
HMO (Health Maintenance Organization) An HMO is a Medicare Advantage plan where, other than emergency, your health care is managed by a primary care physician. The primary care physician refers its patients to the appropriate specialist. All specialists referred to must be in the plans network. You are not required to go to a network provider in the event of an emergency. Arizona Medicare Advantage plans are generally available by county and some companies even go by zip codes.
PPO (Preferred Provider Organizations) An Arizona Medicare Advantage PPO differs from an HMO in a couple of important ways. You are not required to go to your primary Physician to have a referral to see a specialist. Also, you can see a provider that isn’t in the network, but you would have to pay higher copays. Once again Arizona PPO plans have a network and are available by county or sometimes cities.
PFFS (Private fee For Service) Medicare beneficiaries in Arizona can opt for a Medicare Advantage PFFS plan. An individual enrolled in a PFFS can go to any Medicare-approved doctor or hospital that accepts the plan’s payment terms and agrees to treat you. However, not all health care providers will. In some PFFS that have a network, an individual may be able to go out-of-network for certain services usually, for a higher cost. Arizona plans are generally available by county of residence.
POS (Point of Service) Like an HMO, an Arizona Medicare Advantage POS plan requires that you have or select a primary care physician from within the plan network. And like a PPO plan, you have the option of using out-of-network physicians. The difference is that an out of network provider must first be approved by the plan. Unapproved out-of-network care will not be covered by the plan or by Medicare. In addition, you usually pay more for an approved out-of-network service than for the same service in-network.
SNP (Special Needs Plans) Special Needs Plans (SNPs), a form of Medicare Advantage plan, were authorized in 2003 to provide a managed care option for three groups of beneficiaries with significant or relatively specialized care needs 1. Medicare beneficiaries who are dually eligible for Medicare and Medicaid (In Arizona AHCCCS) 2. Beneficiaries living in nursing homes or other institutions. 3. Beneficiaries with severe chronic or disabling conditions. Several companies in Arizona offer SNP plans To learn about Medicare Supplements and Medicare Part D Plans fill out a contact form or call Ralph at 602-390-8573