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ConnectiCare Medicare OTC catalog 2020

ConnectiCare Medicare OTC catalog 2020

ConnectiCare Medicare OTC catalog 2020

ConnectiCare plans offer members many great benefits including the ConnectiCare Medicare OTC catalog 2020.

This blog has been updated – Click here for more infomation.

ConnectCare will send eligible DSNP members their OTC card in the mail.  Once you receive, you can use it at any in-network retail store or pharmacy.  The participating pharmacies include; CVS, Rite Aid, Walgreens and Walmart.  If you would like to check to see if your pharmacy participates, you can either visit otcnetwork.com or call 1-888-682-2400.  You will also be able to check your monthly card balance if you go to the website or call the number listed.

Eligible members can use their over-the-counter (OTC) card for either approved non-prescription health items or OTC medications.  This provides members with a benefit of up to $50 per month. There is an annual benefit maximum of $600 on eligible items.

TO DOWNLOAD/VIEW THE CONNECTICARE OTC PRODUCT FLYER, CLICK HERE

Please note:  If you do not use your entire monthly benefit, additional amounts do not roll over to the following month.

There are many items eligible for this benefit including:

Adult pain medication

Allergy medication

Antacids

Cold/Flu medicine

Dental care including denture care items (toothpaste)

Ear and Eye drops/wash

laxatives

Shampoo

You can also purchase vitamins and minerals as part of the OTC benefit.

To view a complete list of approved items eligible for purchase with your OTC card;  please check the plan documents you receive with your new card

Click here to go to our free Medicare plan comparison site

If you need help choosing the correct Medicare plan, please contact us either at (203)796-5403 or by email at teal@croweandassocites.com.  For more information about what we offer our clients, visit our website; croweandassociates.com.

 

 

 

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Wellcare OTC catalog 2020

Wellcare OTC catalog 2020

If you are a current member of a Wellcare plan, you will definitely want to have a copy of the Wellcare OTC catalog 2020.  Wellcare offers it’s clients convenient self-service tools you can use to order OTC items 24/7. The OTC program gives you an easy way to get health items such as; bandages, (non-prescription) pain relievers, vitamins and even toothpaste.

INFORMATION ON THIS PAGE HAS BEEN UPDATED; CLICK HERE TO ACCESS THE NEW PAGE.

There are 2 ways to order OTC items from Wellcare:

  1. You can order on line from the Wellcare website www.wellcare.com/medicare.
  2. Order using the Interactive Voice Response system (IVR).  Just call the number that is on the back of your ID card.

Click here to download the 2020 Wellcare OTC Catalog

Look through the catalog, then place your order either online or over the phone and Wellcare will ship your items to you at no cost.

To order online, go to www.wellcare.com/medicare and log in.  If you have not yet created an account, you can sign up by following the instructions on the website.  Once you have an on line account you can use it to:  Order OTC items.  Request member materials.  Pay your bill.   Make a PCP change. You can even look up costs for things such as; co-pays for PCP, specialists or hospital visits.

You can also order over the phone using the number on the back of your ID card.   This number is also listed by state at the back of the catalog.  The IVR (interactive voice response system) can also help you with things such as:  enrollment status, current PCP assignment, making premium payments as well as placing OTC orders.

Wellcare also offers it’s members the convenience of a free mobile app to download.  The app is called:  MyWellCare.  The app offers you a way to view a  list of wellness services or find doctors or urgent care facilities.

Each plan offers it’s members different OTC benefit amounts.

To find out the amount of your benefit, you can either look at your Evidence of Coverage page or your plans Summary of Benefits.  Both can be found in the welcome packet you received with your new card. offers different OTC benefit amounts.

Keep in mind:

Your OTC benefit and items are intended for only your use.  Do not forget to take advantage of this benefit.
The Catalog may have changes each year so be sure to take a look at the new catalog when you get it so you will have an up-to-date list of available options.

If you would like to do a Medicare plan comparison; click here to use our free quote link.

to learn more about what Crowe and Associates offers; visit our website.

 

 

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United Healthcare OTC catalog 2020

United Healthcare OTC catalog 2020

If you are fortunate enough to be a member of a United Healthcare Medicare plan, you may have access to the benefits offered by the United Healthcare OTC catalog 2020.

INFORMATION ON THIS POST HAS BEEN UPDATED.  CLICK HERE TO ACCESS THE UPDATED PAGE.

CLICK HERE TO DOWN LOAD THE 2020 UNITED HEALTHCARE OTC CATALOG.

Some United Healthcare Medicare plans include the Health Products Benefit (OTC allowance).  If you would like to know your specific benefit amount; call the member service number on the back of your member ID card.  You can also refer to the member welcome kit you should have received when you got your new card.

Each quarter you can order approved health products from the catalog, but you must follow these guidelines:

1.  The products are solely for the use of plan member..
2.  Only products from the catalog are covered.
3.  Your order total must be at least $30 or more.
4.  Shipping and handling is included at no extra cost.
5.  You may not redeem any unused credit for cash.

United Healthcare OTC catalog 2020:

Orders will be delivered in 4–5 business days in the continental U.S.

Please note: If you do not use your quarterly benefit, it will not be carried forward.  Each United healthcare Medicare plan offers it’s member a specific benefit amount.  You should contact your provider to verify what your quarterly OTC benefit amount is.

How to order OTC items

There are a few different ways you can use your benefit credits:
1.  Create an online account by going to www.HealthProductsBenefit.com and place your orders there.

2.  You can call 1-800-933-2914, TTY 711.  Customer service representatives are available Monday – Friday from 7a.m. until 7p.m. (Central time) and on Saturdays from 7a.m. until 4p.m. (Central time)

3.  Use a mail order form and send your order through the postal service. You should receive a mail order form and envelope with your welcome kit.

Additional information:  FirstLine Medical is a DBA of OptumRx and is the supplier of all the products available in the catalog.

If you would like help choosing the best Medicare plan for your needs; please contact us.  You can reach us either by phone at (203)796-5403 or by email at teal@croweandassocaites.com.

Please visit our website for more information at croweandassociates.com.

If you would like to compare health plans; visit our free quote site by clicking here.

What is the difference between a Medicare Advantage plan and a Medicare Supplement Plan? Click here for information.

 

 

 

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Anthem OTC catalog 2020

Anthem OTC catalog 2020

If you are a member of an Anthem Medicare plan, you may have the benefit of the Anthem OTC catalog 2020.  There is a link provided below to access the catalog

CLICK HERE FOR UPDATED INFORMATION

TO DOWNLOAD THE ANTHEM 2020 OTC CATALOG, CLICK HERE

Use your catalog of OTC items to save money using the monthly allowance.  The catalog allows you to choose from a variety of over the counter (OTC) drugs, vitamins and other health related items at Walmart.  It’s very easy and simple to use.

There are 3 ways to use your OTC benefits.  Feel free to use the one that works best for you.

1. Buy in-store for convenient and easy access to the things you need. Shopping locations are available at locations in your area.

2. An online order may be your preference.  You can shop for the items you need online or use the available mobile app to order and pick up in the store. Delivery is also an option. Look at the instructions that came with your OTC card for more details.  You can find the Anthem Healthy benefits app either on Google play or Apple.

3. Call for delivery
Look up the product in this catalog and call 1-866-413-2582 (TTY: 711) for delivery to your home.  If you cannot find the item you need, call customer service at the number listed on your id card.

More about your OTC card benefit:

When do I get my OTC Benefit Card?
After you enroll in a plan, the card is automatically mailed to you.  If you need a replacement card,  contact the OTC customer service line at 1-866-413-2582 (TTY:711).

Every month you have a dollar amount to spend on non-prescription OTC items and health products. There are many different items included in this program.   Some examples are: antacids, cough drops and first aid items,  as well as vitamins.

Some rules apply to how to use this benefit:

You may use the benefit only for approved items.

This benefit is for use by the member only.

If the amount of your purchase is more than your benefit allows; you will need to pay the difference.

You can call the customer service number on the back of your ID card, if you have any questions.

If you do not find the item you are looking for; go to the Anthem website at www.HealthyBenefitsPlus.com/AnthemBCBSOTC to view a list of all the available items.

In addition:

The only plan members who had a decrease in their OTC benefit are the Some HMO $0 members  ($59/quarter in 2019 to $30/quarter in 2020).

All other plans had an increase in the OTC benefit amount.

Looking to quote or compare Medicare Advantage, Part D or Medicare supplements plans?

Use the link below to quote, compare, check doctors and run drug comparisons. CLICK TO COMPARE PLANS.

Please feel free to contact our office if you have any questions about your health plan or need assistance with healthcare products.  You can reach us either at (203)796-5403 or by email at teal@croweandassociates.com.

Click here to learn more about Medicare Advantage Plans VS Medicare Supplement Plans.

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Aetna Medicare OTC catalog 2020

Aetna Medicare OTC catalog 2020

The Aetna Medicare OTC catalog 2020 can be found online:

The quickest and easiest way to place your OTC order is to go online to CVS.com/otchs/myorder.

THE INFORMATION ON THIS PAGE HAS BEEN UPDATED – CLICK HERE TO ACCESS THE NEW PAGE.

This method of ordering allows you to place an order 24/7.  way to order 24/7 is to visit
You can also order by phone.  Just call 1-833-331-1573 (TTY:711).  There are representatives available Monday – Friday 9:00 am until 8:00 pm (ET).

You can download the 2020 catalog by using the the link below:

CLICK HERE TO DOWN LOAD THE 2020 AETNA OTC CATALOG.

What is an OTC Catalog?

Many of the Aetna Medicare advantage plans have an OTC benefit.  This benefit provides each member a monthly fixed amount of money to use to order common OTC items available at your local pharmacy.  This benefit includes items such as; first aid supplies, vitamins, eye drops and cough drops as well as many other most other items.  The monthly benefit with most plans does not roll over month to month.  In other words, it is a use it or lose it system.

Please note:

During the first and last week of the month, Aetna usually has a high volume of calls. Therefore, it is easier to get through for OTC orders in the middle of the month. OTC orders can be placed at any time during the month.  Call to place an order Monday through Friday, 9 AM to 8 PM EST.  If you do not get your order within 7 to 10 business days after ordering, you can call the following number  1-833-331-1573 (TTY:711).  This number should also be used for those that would like to place an order.

Quote Medicare plans

If you want to quote and compare all companies Medicare Advantage and Medicare supplement plans, you can do so using the link. You can also run plan comparisons, check doctors and drugs and run drug cost comparisons from plan to plan.  Our link does not require any type of commitment to use and you will not get any phone calls from sales people if you use it.     

CLICK HERE TO QUOTE AND COMPARE PLANS

If you have questions about healthcare plans, please contact us either by phone at (203)796-5403 or email at edward@croweandassociates.com.

Learn more about the services that Crowe and Associates offers.

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Medicare supplement rates 2020

Medicare supplement rates 2020

Our Medicare Supplement rates 2020 blog gives you access to current Medicare supplement rates in all states.   Medicare supplement rates are based on a number of criteria depending on where you live.  Some states allow for rates to be based on both age and gender. Other states have the same rates for everyone regardless of either age or gender.

Important; Medicare supplements are standardized in most states.  As a result, if a company is offering a plan N supplement (also called Medigap), they must provide benefits identical to those of every company offering that plan.  The only difference will be in the rates. As a result,  it is easy to compare supplement plans from carrier to carrier.  First you should know the benefits offered for each letter plan.*  Additionally, most states will update rates on a quarterly basis.

*Although the base benefits are the same, some plans may add additional benefits that are not base Medicare benefits.  An example would be a plan that offers Silver Sneakers.  They are not required to offer it but may choose to as a value add.

Want to run your own quotes?  CLICK HERE TO USE OUR MEDICARE QUOTE SITE

Can everyone get a Medicare supplement?

The insurance companies are able to check health for some people that want a Medicare supplement plan.  There are times when you have a guaranteed issue right to a supplement.  Some of them are listed here.

  • Guaranteed issue – No underwriting (checking of health) allowed
    • Turning 65 or first eligible for Medicare
    • Coming off of group/employer coverage
    • Live in a state that does not allow underwriting -CT,NY,MA,ME
    • Have a trial right.  Learn about trial right
    • Moving to a new state

How are Medicare supplements different than Medicare Advantage plans?

To view the Medicare Supplement rates in your state; just click on the links below. In addition, we offer a quote tool that can be used to access rates for Medicare supplement, Medicare Advantage and Medicare part D plans (PDP plans) at no cost.  Please feel free to use it.

If your state is not listed below, please use the Medicare.gov site link or our quoting link below.

MEDICARE SUPPLEMENT RATES AND BENEFITS

Medicare quote site click here – Access all rates for all types of Medicare plans in any state on this site

Medicare.gov Medicare supplement rate comparison

Alabama Medicare supplement rates

Alaska Medicare supplement rates

California Medicare supplement rates

Connecticut Medicare supplement rates

Florida Medicare supplement rates

Georgia Medicare supplement rates

Hawaii Medicare supplement rates

Iowa Medicare supplement rates

Maine Medicare supplement rates

Maryland Medicare supplement rates

MA Medicare supplement rates

Missouri Medicare supplement rates

New York Medicare supplement rates

Nebraska Medicare supplement rates

Nevada Medicare supplement rates

North Carolina Medicare supplement rates

Oklahoma Medicare supplement rates

Oregon Medicare supplement rates

PA Medicare supplement rates

South Carolina Medicare supplement rates

Tennessee Medicare supplement rates

Texas Medicare supplement rates

Washington Medicare supplement rates

Wisconsin Medicare supplement rates

Wyoming Medicare supplement rates

 

To learn more about Medicare Supplement plans; either click here or contact Crowe and Associates at 203-796-5403 or by email lisa@croweandassociates.com.

 

 

 

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Medicare Supplement cost comparison

Medicare Supplement cost comparison

If you are either new to Medicare or if you want to change plans during open enrollment, a Medicare Supplement cost comparison is a great idea. Click Here For A Medicare Supplement Cost Comparison Tool-  Free to use at no cost or obligation    (Good for all 50 states)

Medicare Supplement cost comparison – things to know:

Medicare Supplement plans and Medigap plans are the same thing.  Private insurance companies offer these plans.  The insurance companies can only  sell you standardized plans.  This means the plans offer the same general benefits although some plans offer added benefits.    In other words, plan N on Anthem must offer the same benefits as a Plan N on United Health Care.  The real difference is the cost of each plan as well as the extra benefits one company offers over another. All insurers must follow both federal and state laws.  The laws protect consumers.

Medicare Supplement cost comparison – more information:

A Medigap policy helps you pay for health care costs left over after Medicare A and B have paid their portion.  This applies to things such as; co-pays, co-insurance and deductibles.  If you enrolled in Original Medicare as well as a Medicare Supplement/Medigap policy, then each policy will each pay it’s part of your covered health care costs. In most cases, when you buy a Medicare Supplement plan, you must have both Medicare Part A and Part B. (Sign up for Medicare A and B)  There is a  monthly premium for Medicare Part B.  There is also a premium for Med Sup/Medigap policies.

Renewing the plans

Your policy is guaranteed renewable as long as you pay your premium.  This policy will renew automatically each year. Medicare Supplement cost comparison: If you are considering a Medicare Supplement/Medigap policy, you should definitely compare the costs.  You should do this each year before open enrollment as prices change as well as extra benefits that are offered. This is true especially because the benefits you receive the same coverage no matter which carrier you choose.  The only difference is the cot of the plan.

Links to rates for each state

Federal Medicare Supplement Website Medicare Supplement cost comparison

Alabama rates site

Alaska rates site

Arizona rates site

Arkansas rates site

California rates site

Colorado rates site

Connecticut rates site

Delaware rates site

Florida rates site

Georgia rates site

Hawaii rates site

Idaho rates site

Illinois rates site

Indiana rates site

Iowa rates site

Kansas rates site

Kentucky rates site

Louisiana rates site

Maine rates site

Maryland rates site

Massachusetts rates site

Michigan rates site

Minnesota rates site

Mississippi rates site

Missouri rates site

Montana rates site

Nebraska rates site

Nevada rates site

New Hampshire rates site

NJ rates site

New Mexico rates site

NY rates site

North Carolina rates site

North Dakota rates site

Ohio rates site

Oregon rates site

Pennsylvania rates site

Rhode Island rates site

South Carolina rates site

South Dakota rates site

Tennessee rates site

Texas rates site

Utah rates site

Vermont rates site

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Dental, Vision & Hearing plan

Dental, Vision & Hearing plan

If you are looking for a great all-in-one package of health care products, look no further.  Our Dental, Vision & Hearing plan package will provide you with the coverage you need at a price you can afford.  These plans are offered by SureBridge.  SureBridge is an affiliate of the Chesapeake Life Ins Company and a recent partner of the UnitedHealthcare Group family of companies.

Plan Details:

Pays 100% on preventative services on DAY ONE of the policy with no deductible

No waiting period on basic benefits (fillings and simple extractions)

Only a 9-month waiting period for major services on dental

Benefits on basic and major services go up 10% every year for the first 3 years.

Issue ages 0-90

ISSUE AGE rates – Premiums are locked in

All applications, contracting done online

Guarantee issue and renewable for life

Carrier pays the provider directly

Click here for more information/brochure

►Now Available: AL, AR, AZ, CO, CT, DE, FL, GA, IA, ID, IL, KS, ME, MI, MN, MS, NE, OK, OR, PA, SC, SD, TN, WI, WV and

WY!

►Launching 6/21: LA, MO, ND,

NM, NV and UT

►Launching 7/19: TX, KY and OH

(More States to come for 7/19

Launch!)

Network Information:

Dental = Carrington Dental Network

Vision = No network

Hearing = TruHearing

**Out-of-network is based on 75% of what dentists in the area are charging.  (UCR)

To see the plan rates for your state click here

 

Click here to learn what sets us apart from other uplines.

 

 

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Medicare Part B premium appeal form

Medicare Part B premium appeal form

The standard Medicare Part B monthly premium for 2022 will be $171.00.  Medicare Part B is what you use to pay for medical costs of doctor’s visits, medical equipment and outpatient procedures.  If you have a MAGI that is over the Medicare maximum amount, you can file a Medicare Part B premium appeal form.

However, if you have a high income level, Medicare might make you pay a higher amount for your part B premium. Medicare uses your modified adjusted gross income or MAGI to decide the amount you will pay for your Part B premium. They take this amount from your tax return from 2 years ago.  This means that if you have Medicare Part B in 2022, your premium is based on your MAGI from your 2020 tax return.

If your income has gone down from what it was 2 years ago, you can use the Medicare Part B appeal form below to file an appeal and have your Part B premium lowered. In some circumstances, a life changing event can significantly reduce your income.  There are many reasons that you can experience a reduction in income.  These instances include divorce, death of a spouse, loss of a pension just to name a few.

Medicare Part B Appeal Form   Click here for an appeal form

If you are more comfortable with an in-person meeting, you can call 1-800-772-1213 to schedule a meeting t your local Social Security office.

If you want a better idea of what the IRMAA is, take a look at the chart below:

THE INFORMATION BELOW HAS BEEN UPDATED.   CLICK HERE TO ACCESS THE CURRENT TABLE.

This chart is for 2019 Part B premiums, if your yearly income in 2017 was: You pay each month (in 2019)
Individual tax return File joint tax return File married & separate tax return
$85,000 or less $170,000 or less $85,000 or less $135.50
$85,000 up to $107,000 $170,000 up to $214,000 Not applicable $189.60
$107,000 up to $133,500  $214,000 up to $267,000 Is not applicable $270.90
$133,500 up to $160,000  $267,000 up to $320,000 Not applicable $352.20
$160,000 and less than $500,000  $320,000 and less than $750,000  $85,000 and less than $415,000 $433.40
$500,000 or above $750,000 and above $415,000 and above $460.50

Medicare Part B Appeal Form – Income for extra help

If you fall below certain income levels you may qualify for extra help paying for your Part B or Part D premiums. Click here for details.

Would you like help with your Medicare coverage? Please feel free to contact our office.  You can reach us either by phone (203)796-5403 or email teal@croweandassociates.com.

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PPO

PPO

If you are or ever have been in the market for a healthcare plan you will most likely come across the term PPO.  A PPO is a preferred provider organization. These plans offer a network of healthcare providers for their members to use for medical care at a negotiated rate.  PPO plans allow members to see any in-network health care provider they choose without requiring a referral.

More PPO information:

If you choose to join a PPO, in most cases, you will not need to choose a primary care provider.  You will be able to use any provider within the company’s network of providers. All your in-network healthcare services will be covered at the negotiated rate.  You will also have the option of using out-of-network providers, although they will be covered at a lower rate. It is always a good idea to make sure your provider participates with your health plan in order to avoid receiving a higher than expected medical bill.

In most cases you will have a deductible to meet each year before your medical bills are covered by the insurance company.  There is also the matter of co-pays for certain services.  Some services will require you to pay a percentage of the total medical cost. These are things you should be aware of, if possible, before you go for medical care.

PPO Providers:

PPO plans have a number of in-network doctors and medical facilities you can choose from. In this way the plans are similar to HMOs.  It is always more cost effect to use an in-network provider when seeking medical treatment. Providers who participate with your insurance company have an agreement to accept lower payments and in return, receive access to patients who participate with the insurance company’s network.  One advantage to a PPO is that beneficiaries do receive coverage for some out-of-network care. If you decide to use an out-of-network provider you will most likely have to pay a higher rate for your care but the insurance carrier will pay some of the cost.

Another benefit of joining a PPO is that you will not be required to get a referral to see a specialist.  You can choose from any in-network provider for medical services

PPO plans might be a good fit for you if:

  • You do not want to get a referral before seeing a specialist.
  • Sometimes you want to use an out-of-network provider.
  • It is important for you to have the choice of where you receive your medical care.

 

If you would like help choosing a Medicare plan, click here

To set up an appointment with a sales rep, please contact us either by phone (203)796-5403 or by email teal@croweandassociates.com.

Does Medicare Cover Home Healthcare

Does Medicare Cover Home Healthcare

Does Medicare cover home healthcare; If you are getting ready to sign up for Medicare you might ask the question.  This can be a very important question to know the answer to.  As we all get older, we do not want to worry about what will happen to us if we become too ill to take care of ourselves.

Medicare will not pay for the following types of care:
  • 24-hour-a-day home care (live in health care).
  • Meal delivery to your home.
  • Services that pay people to shop, clean and or do laundry for those who need assistance.
  • Medicare does not pay for Personal care given by home health aides.  This care consists of bathing, dressing, and using the bathroom.  If this is the only help you need.

Does Medicare cover home healthcare; Medicare will cover your home healthcare services if you meet all the criteria below:

  1. If your healthcare provider decides that you require in-home medical care and makes a plan for you to receive that care.
  1. There must also be a need for either skilled nursing care or  physical, occupational and or speech-language therapy.
  1. You employ a home health agency that is approved by Medicare.  The agency must be Medicare-certified.

4. It must be proven that you are unable to leave your home without help and a great amount of effort.  In other words you must be home-bound. You can still leave home occasionally  short,               periods of time for both medical and non-medical reasons.  If you use adult day care, you can still qualify for home health care.care will cover the following types of home health care

CLICK HERE TO SIGN UP FOR MEDICARE ON LINE

Medicare will pay for the following medical care, when you meet all the requirements:

Part time skilled nursing care.  This means any service that only a licensed nurse can do safely.

If you require the services of a part time home health aide for personal care such as bathing, dressing or using the bathroom.  These services include things that do not need to be done by a licensed nurse.  Medicare will not pay for the home health aide unless you also require therapy or other nursing care.  These services must be a part of your at home treatment plan for your current health condition.

Physical, occupational or speech therapy for any amount of time the doctor recommends.

In order for Medicare to pay for any therapy, they should be prescribed in order for you to regain your quality of life as it was before the on set of your current health condition.

Medicare will also pay for approved, necessary medical supplies such as wound coverings ect.   It does not include either prescription drugs or biological therapy.

Durable medical equipment such as canes, walkers or wheelchairs are also covered by Medicare.

FDA approved injected osteoporosis drugs are also paid for by Medicare when deemed necessary in certain situations.

Please remember; although your health care provider helps with the arrangement for Medicare covered home health care, the final word is yours as to which agency you use.

If you need help choosing the best Medicare plan for yourself, please contact us.  You can reach us either by phone (203)796-5403 or email teal@croweandassociates.com.

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HMO vs PPO

HMO vs PPO

How do HMO and PPO Plans differ?

There are many choices to make when it comes to your health insurance. You may be familiar with the terms HMO and PPO.  You may not know what the letters stand for or what the differences in the plans are.  Let’s start by telling you what these initials mean.  An HMO is a Health Maintenance Organization.  A PPO is a Preferred Provider Organization.  We will give some information about HMO vs PPO plans in this post. Note: Medicare Advantage plans also have HMO and PPO plans designs.  The information is applicable to Medicare MA and MAPD plans as well.

We have listed some information about each type of plan below:

HMO vs PPO:

If you opt for an HMO, you will have to use specific in-network facilities as well as doctors.  This network is made up of  health care providers who have agreed to accept lower payment rates from members while meeting quality standards put in place by the insurance company.  Medical care under an HMO plan is covered only when you use an in-network provider. There is very little opportunity to use the services of an out-of-network provider.

More HMO information:

 

  • The premium for these plans is usually lower for HMO plans.
  • In most cases, the deductible is either low or there is none
  • You will need to choose a primary care provider (PCP)with most of the HMO plans.  This provider decides what medical care you need.  This means that provider will have to decided if you need to see another doctor for any reason.
  • Usually, if you need a specialist your PCP will have to refer you to them. If your PCP does not give you a referral, your medical expense may not be covered.
    • There are Open Access HMO plans that do not require a referral to see a specialist
  • If you use a doctor who is not in the network, you will have to pay the entire cost out-of-pocket because, there is no insurance coverage.
    • A medically necessary emergency room visit is in network on an HMO plan

 

HMO vs PPO:

If you choose a PPO plan, you will also have a network of providers.  The difference with these plans and an HMO is you can go to certain out-of-network providers. The plan will pay less towards your medical expense than an in network provider; but at least it will pay part of your cost.

More PPO information:

  • The premiums for these plans are usually higher than with an HMO.
  • In most cases, there is a deductible.
  • You do not need a referral from your PCP before going to any doctor or specialist.
  • If you need to use a provider who is not in network, you may have some of your expense covered. Keep in mind, you  will have better coverage using in-network providers.

The decision to choose one health care plan over another depends on many factors.  These factors include your health, your budget and the network of providers available for each plan.

Click here for information about choosing the right Medicare Plan

If you would like more information about choosing a Medicare health plan, please contact us.

You can reach us either by phone (203)796-5403 or by email teal@croweandassociates.com.