Traveling with Medicare

…cover providers that are out-of-network or out of your service area, but with higher cost-sharing (copayments, coinsurances). Your plan may also impose other rules or restrictions (like prior authorization). Contact…

Questions to ask before joining a Medicare Advantage Plan

…If my providers are not in-network, will the plan still cover my visits? Which specialists, hospitals, home health agencies, and skilled nursing facilities are in the plan’s network? Access to…

Comparison: PFFS, HMOs, and Original Medicare

…provider and use any facility that accepts Medicare (participating or non-participating) See any provider, but may pay more when seeing out-of-network providers See only in-network providers   Visit doctors anywhere…

Flu shots

…one calendar year. For example, if you get a shot in January 2024 for the 2023/2024 flu season, you could get another shot in October 2024 for the 2024/2025 flu…

HMO costs and coverage

…out-of-network providers for certain services without referral or prior authorization. You may pay more than you would when seeing an in-network provider, but plans must have a limit on your…

Medicare Advantage basics

…MA Plan are: Health Maintenance Organizations (HMOs) Preferred Provider Organizations (PPOs) Private Fee-For-Service (PFFS) You may also see: Special Needs Plans (SNPs) Provider Sponsored Organizations (PSOs) Medical Savings Accounts (MSAs)…

Comparison: PPOs, HMOs, and Original Medicare

…and use any facility that accepts Medicare (participating or non-participating) See any provider, but generally pay more when seeing out-of-network providers See only in-network providers Visit doctors anywhere in the…

PPO costs and coverage

…of $4,000 for your combined in-network and out-of-network costs. You could reach the combined limit by spending $1,000 on in-network services and $3,000 on out-of-network services, or by spending $4,000…

Notices that Medicare Advantage and Part D plans must send if they make changes during the year

…are enrolled in an MA Plan, you typically pay less when seeing in-network providers. In-network providers can leave a plan at any time. When a provider leaves a plan’s network,…

Medicare Advantage appeals if your care is ending

If you are receiving care from a hospital, skilled nursing facility (SNF), Comprehensive Outpatient Rehabilitation Facility (CORF), hospice, or home health agency and are told that your Medicare Advantage Plan…