Medicare Advantage FAQ

Q: What are Medicare Advantage Plans?

Medicare Advantage plans, also known as Medicare Part C, are health plan options that are Medicare-approved. If you join one of these plans, you generally get all your Medicare-covered healthcare through that plan. This coverage can include prescription drug coverage.

Q: What is a Medicare Advantage Private Fee-for-Service Plan?

A Medicare Advantage Private Fee-for-Service (PFFS) Plan is a type of Medicare Advantage Plan (Part C) in which you have the freedom to choose any doctor or hospital that accepts the plan’s terms and conditions.* The insurance plan, rather than the Medicare Program, decides what you’ll pay for the services you will receive. You may pay less for Medicare-covered benefits. You may have extra benefits the Original Medicare Plan doesn’t cover. These plans are available as stand-alone health plans or with prescription drug coverage (called MA-PD plans).

Q: What is a PPO (Preferred Provider Organization)?

Medicare Advantage PPO plans are designed to reduce the cost of healthcare by contracting with certain doctors, labs, and hospitals to provide care at a discounted rate for its members. You will save the most when you utilize our comprehensive network of care providers, but a PPO will also pay a portion of your healthcare costs if you choose a doctor or hospital that isn’t in the network, but agree to accept the plan’s payment terms and conditions.

Q: With a PPO, is my choice of doctors limited?

No. You may go to any doctor, specialist, or hospital anywhere in the U.S. that agrees to accept the plan’s payment terms and conditions, though you will enjoy optimum savings when you choose a doctor within your local Today’s Options PPO network.  You may be subject to somewhat higher copays and coinsurance if you choose a doctor or hospital outside the Today’s Options PPO network.  

Note: With a PPO, your plan will still cover a percentage of the cost when you choose an out-of-network provider for all covered services, as long as they are medically necessary. With the exception of emergency or urgent care, it will cost more to get care from non-plan or non-preferred providers. Member responsibility will be greater out-of-network when the out-of-network coinsurance is based on the Medicare allowed amount and the contracted amount is lower.

Q: What is an HMO (Health Maintenance Organization)?

HMO plans are a type of Medicare Advantage Plan (Part C) that includes all your Part A (hospital insurance) and Part B (medical insurance) benefits. HMOs also cover additional benefits, like extra days in the hospital, and dental and vision care. With most HMOs, you can only go to doctors, specialists, or hospitals in the plan’s network, except in an emergency. That allows us to offer you significant savings over Original Medicare.

Q: How does an HMO work?

By working with a select team of doctors and hospitals, HMOs are able to keep costs low. When you join an HMO, you may go to any doctor or hospital that is included in the network. In addition, you will be asked to choose a primary care doctor. This doctor will coordinate all of your medical care, including choosing specialists when additional care is needed. However, with the exception of emergency situations, if you choose a doctor or medical facility that is not included, you will be responsible for all costs.

When you join an HMO, you’re still enrolled in the Medicare Advantage program and entitled to all medically necessary healthcare services that are Medicare-approved. However, as a HMO member, you will enjoy deductibles, copayments, and coinsurance amounts that may be substantially lower than those under Original Medicare.

Q: How is a PPO different from an HMO?

PPOs and HMOs both offer members guaranteed lower costs on doctor visits, hospital stays and other services when the member chooses a network provider. The difference lies in the amount you pay out of pocket when using an out-of-network provider. You are liable for 100 percent of the cost when choosing a provider that is not in your HMO network. With a PPO, your plan will still cover a percentage of the cost when you choose an out-of-network provider.

Note: With a PPO, your plan will still cover a percentage of the cost when you choose an out-of-network provider for all covered services, as long as they are medically necessary. With the exception of emergency or urgent care, it will cost more to get care from non-plan or non-preferred providers. Member responsibility will be greater out-of-network when the out-of-network coinsurance is based on the Medicare allowed amount and the contracted amount is lower.

Q: How does a Medicare Advantage PFFS (Private Fee-for-Service) plan work?

When you join a PFFS, you’re still enrolled in the Medicare Advantage program and entitled to all medically necessary healthcare services that are Medicare-approved. As a Today’s Options member, however, you’ll enjoy the added advantages of low co-payments for doctor and hospital visits and access to preventive services. You have the freedom to choose any doctor, specialist or hospital in the U.S. that accepts the terms and conditions* of the Today’s Options plan.

*A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital can continue to treat you if it agrees to accept our terms and conditions of payment, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan’s terms and conditions on our website at: www.todaysoptions.com.