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18 WWW.UNWLA.ORG “НАШЕ ЖИТТЯ”, ЛИСТОПАД 2014 If you have the Medigap supplemental insur- ance, you are free to go to any provider, and NO NETWORKS ARE INVOLVED. Most visits to Medicare providers are free. You have the choice of many private insurance companies for both Medigap and Part D. Cons : It is the most expensive option, BUT it is your health and you will have the best coverage. III. Medicare Complete/Medicare Ad- vantage PPO Plan Both PPO and HMO plans are an alterna- tive to Medicare. Unlike Medicare, these plans may give you broader benefits (dental and vision plans or discounts, wellness services, gym mem- bership, etc.) in exchange for receiving health care within the plan’s network of providers. REVIEW: PPO - Preferred Provider Organ- ization Pros : You have flexibility to visit any doctor in or out of your network. No referrals are needed because your medical visits are not controlled by a primary doctor. You pay a set copay for your family doctor and a higher copay for an in-network specialist. Prescription Plan D coverage is usually includ- ed at no extra cost. You have the opportunity for broader benefits, depending on the insurance company. You are responsible for a maximum yearly out- of-pocket cap. During years of minimum medical expenses, this option can result in big savings in compar- ison to a Medigap plan. Registered nurses are available toll-free twen- ty-four hours a day. Each insurance carrier has several plans with different premiums and different pay scales to the network providers. Cons : Physicians may resign from the plan’s network and you may lose your favorite doctor/s. You will pay more for benefits outside of your network. In cases of serious medical expenses, you must pay yearly out-of-pocket amount. Since insurance companies pay lower fees to providers, fewer physicians sign up with net- works than with Medicare. IV. Medicare Complete/Medicare Ad- vantage HMO Plan Except for emergencies, your coverage is limited within a specific network and location. REVIEW: HMO - Health Maintenance Or- ganization Pros : HMO plans are the least expensive. Your medical costs are predictable because you are only responsible for copayments. Since your primary doctor controls all your visits to specialists, he has your complete med- ical records. You normally pay a copay at the time of ser- vice. This fixed dollar amount—$10, $25, $50—depends on the HMO. Prescription Plan D coverage is usually includ- ed at no extra cost. Registered nurses are available toll-free twen- ty-four hours a day. Cons : Except for emergencies, you MUST go for med- ical care within your plan's network, or you will not be covered. You MUST choose a primary care doctor from your plan's network. You need to follow the plan’s very strict rules such as prior approval for certain services and referrals from your primary care doctor to see a specialist. This process may take time. Because it is the most economic plan wherein insurance companies pay lower fees to provid- ers, fewer physicians sign up with HMO net- works than with Medicare or a PPO network. Hence, you may have a restricted pool of par- ticipating physicians. A big “thank you” to President Lyndon B. John- son (D) for signing the Medicare program into law on July 30, 1965!
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