Amplicare provides you with all of your Medicare Part D plans. See the difference below!
Prescription Drug Plans (PDP)
PDPs are stand-alone Medicare Part D plans. 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.
Medicare Advantage Plans (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”, are provided by private insurers.
There are different types of MA-PDPs:
Health Maintenance Organization (HMO)
Generally these plans are lower cost but more restrictive. HMO plan premiums tend to be lower, but they will only provide coverage for doctors that are in the plan's network. HMO plans almost always require the patient to select a primary care physician (PCP). The patient is required to obtain referrals from their PCP before they can see specialists (with exception of emergencies).
Preferred Provider Organization (PPO)
PPO plans are less restrictive but oftentimes more costly. They will provide coverage for doctors that are not part of the plan's network, but the patient will have to pay more to see these doctors, and referrals for specialist visits are typically not required. Out-of-pocket costs (premiums & deductibles) tend to be higher.
Point-of-Service plan (POS)
POS plans are a hybrid between HMO and PPO plans. Patients designate an in-network primary care 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).
Some plans may not allow the patient to see certain doctors because Medicare Advantage plans have limited doctor networks. It's important that patients confirm the doctor network for any Medicare Advantage plan that they're considering.
You can check if a doctor is covered by the plan through the Doctor Lookup tool!
Special Needs Plans (SNP)
SNPs are a specific type of MA-PDP. SNPs provide specialized coverage for patients with certain 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:
This is the most common SNP. The patient must be dual eligible (receiving both Medicare and Medicaid) to enroll.
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.
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!
Medigap is a supplemental health insurance that patients can purchase to cover costs not covered by Original Medicare such as copays and deductibles. Medigap policies are only available for patients who already have Medicare Part A and B. Premiums vary among insurance companies, but the benefits of each plan are the same.
You can learn more about enrolling in Medigap here!
It's important to help your patients understand their enrollment path options, based on plan types, and the pros and cons of each. Here's an explanation!