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Medicare Advantage

Can I See My Own Physician if I Choose a Medicare Advantage Plan?

When Medicare Advantage (Medicare Part C) was created, the idea was to give seniors with multiple options when planning to manage their health care. Some seniors discovered that traditional Medicare (Medicare Part A and Part B) was not adequate to meet their healthcare needs. The various types of plans available through Medicare Advantage give different levels of flexibility for insureds to choose their own provider. While these plans provide more comprehensive services than traditional Medicare, clients are encouraged to visit any doctor or medical facility that accepts payment from Medicare under traditional Medicare.

Health Maintenance Organizations (HMO) and Preferred Provider organizations (PPO) are two sorts of policies you can buy under Medicare Advantage. To find out more about these plans, please visit "Which MA plan is right for me?". The care is referred to as “coordinated” because the plans developed around a network of doctors and medical facilities working together to administer your care. When a plan sets up a “network,” it signs agreements with healthcare providers to provide care to plan members. Each coordinated care plan sets up its own network. The client may have to choose specific doctors and hospitals. This differs from Original Medicare, which permits you to visit any doctor or medical facility that accepts payment from Medicare.

While under an HMO Medicare Advantage plan, you’re required to select a primary care doctor, and that doctor is required to be a member of that HMO’s network. However, with a PPO plan, you may not be required to choose a primary care physician and presumably don’t need to go through a primary care physician in order to see a specialist.

With almost all PPO Medicare Advantage plans, you can see doctors not in the network of doctors who’ve agreed to provide care to the members of a Medicare Advantage plan or Medicare Part D prescription drug plan. These doctors are called "network providers" and "network pharmacies.” When you visit a network provider or pharmacy, you won’t have to pay the entire cost on your own. In those cases, you’ll usually pay a larger share of the cost of your care at a non-network health care provider. For example, the policy could pay 90% of the cost for care received in-network, but only 60% of the cost for the same care provided out-of-network.

It’s critical to look over your Medicare options with a local professional insurance agent. Contact Sun Coast Legacy Advisors today. We can help you determine if the policy you’re looking at will provide the benefits you require from the medical professionals and hospitals you prefer. We’ll go over your options with you and find a suitable plan for your needs.

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