Medicare Advantage, also known as Medicare Part C, is an alternative way for beneficiaries to receive their Medicare benefits through private insurance plans approved by Medicare. These plans must provide at least the same level of coverage as Original Medicare (Parts A and B), but they often include additional benefits such as prescription drug coverage, dental, vision, and wellness programs. HMO plans typically require beneficiaries to choose a primary care physician (PCP) from within the plan's network. In most cases, beneficiaries must obtain referrals from their PCP to see specialists or receive non-emergency care. HMO plans often offer lower premiums and out-of-pocket costs but may have more restrictive provider networks. PPO plans offer more flexibility in provider choice compared to HMO plans. Beneficiaries can generally see any healthcare provider, but they will pay less if they use providers within the plan's network. PPO plans do not require referrals to see specialists, making them a more flexible option for beneficiaries who prefer greater autonomy in healthcare decisions. SNPs are specialized Medicare Advantage plans designed to meet the unique healthcare needs of certain populations, such as individuals with chronic conditions, dual-eligible beneficiaries (eligible for both Medicare and Medicaid), or those residing in longterm care facilities. SNPs tailor their benefits, provider networks, and care coordination services to the specific needs of their target population. 12.2.1 Health Maintenance Organization (HMO) Plans 12.2.2 Preferred Provider Organization (PPO) Plans 12.2.3 Special Needs Plans (SNPs) 12.1 What is Medicare Advantage? 12.2 Understanding Medicare Advantage Networks Chapter 12: Exploring Medicare Advantage Plans 202404PMED1MDSIMPLE 30 www.Postal-Service-Health-Benefits-Program.com
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