Medicare Advantage plans often have contracted groups of doctors, hospitals and other healthcare providers called networks. Sometimes these networks are strictly local to your area and sometimes they’re nationwide. Before enrolling in a Medicare Advantage plan, it’s crucial to ensure that your desired providers are within the plan’s network. Doing so will help minimize your healthcare costs!
Regardless of your plan, networks are one of the most important aspects to selecting health coverage and providers. If you have enrolled in a Health Maintenance Organization (HMO) plan for your Medicare Advantage coverage, you most likely have a network of providers where you can seek care. However, HMO’s only provide coverage within their network (except in true emergencies). HMO’s are great for those who aren’t typically traveling or have a lower budget for their health coverage.
If you are enrolled in a HMO and are dissatisfied with your plan’s network, there are other options. While HMO plans typically have lower monthly premiums and copays, their networks are usually smaller than Preferred Provider Organization (PPO) plans. PPO plans can come with higher monthly premium and copay costs, but in exchange, networks can be much larger. PPO plans are more flexible with out-of-network coverage as well, and are less likely to require a referral to see a specialist.
Have you ever been told that your doctor’s office is changing networks? Medicare Advantage coverage networks have the benefit of connecting you to providers in your area, but those same networks can grow or shrink quickly. Providers can leave your plan’s network at any time, and if your Primary Care Provider (PCP) does so, you must choose another in-network provider in order to continue receiving covered care. In some cases, your PCP is connected to other hospitals and specialist networks, so that can also affect your coverage choices.
Which type of plan are you enrolled in? Are you happy with your health coverage? If you have any questions or concerns about your current coverage, don’t hesitate to give us a call!
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