Amplicare provides you with all of your Medicare Part D plans. See the difference below!

Prescription Drug Plan (PDP) with Original Medicare
PDPs are your standard Medicare Part D plan. These plans include coverage just for your patient’s prescription drug needs. All other coverage (e.g. hospital and medical) will come from "Original Medicare" Parts A and B.  Patients on these plans can also enroll in Medigap coverage.

Medicare Advantage Plan (MA-PDP)
MA-PDPs cover all services provided by Medicare Parts A, B, and D, and sometimes, vision, dental, and hearing. MA-PDPs, also referred to as “Part C” or “MA Plans”, are provided by private insurers.

There are different types of MA-PDPs:

  • Health Maintenance Organization (HMO)
    HMO plans almost always require the patient to select a primary care physician (PCP). The patient is required to visit their PCP who can then refer them to other specialists. The only case when this is not applicable is in emergency situations where urgent care is needed. HMO premiums tend to be lower.
  • Preferred Provider Organization (PPO)
    PPO plans offer a much wider range of providers than HMOs. However, out-of-pocket costs (premiums & deductibles) can be slightly higher. Referrals to outside specialist are typically not required.
  • Point-of-Service plan (POS),
    POS plans are a hybrid between HMO and PPO plans. Patients designate an in-network primary physician, but can also receive services out-of-network for higher copayment or coinsurance.
  • Private Fee for Service (PFFS)  PFFS plans do not require referrals to visit specialists, but copayments and coinsurance tend to be higher for an out-of-network provider. Out-of-network providers may also refuse service for PFFS plan holders (with the exception of emergencies). 

Special Needs Plans (SNP)
SNPs are a specific type of MA-PDP.  SNPs provide specialized coverage for patients with specific needs. These plans often offer more benefits in regards to coordination of care. Like MA-PDPs, they cover all services provided by Medicare Parts A and B, prescription drugs (Part D), and sometimes vision, dental, and hearing.  There are three kinds of SNP plans:

  • D-SNPs  This is the most common SNP. The patient must be dual eligible (receiving both Medicare and Medicaid) to enroll.
  • C-SNP Special Needs plans for patients with certain chronic health conditions. They are available for patients in certain counties.  The most common C-SNPs are for patients with diabetes or heart disease.
  • I-SNP These SNPs are only available for institutionalized patients in LTCs, such as skilled nursing facilities, LTC nursing facilities, intermediate care facilities, or assisted living facilities. They are also available for patients who live at home but require an institutional level of care, also called Institutional Equivalent.

You can learn more about SNP's here!

What’s Next?

Want to better understand the pros and cons of Original Medicare and Medicare Advantage?  Here is a comparison.

You now know the difference between all of the Medicare Part D plans in the market. Learn about plan’s network preferred statuses here! 

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