AARP Medicare Complete plans are Medicare Advantage health insurance plans underwritten and insured by UnitedHealthcare. Medicare Advantage plans, also known as Medicare Part C plans, replace Original Medicare (Medicare Part A and Part B) coverage and provide additional benefits not included in Original Medicare. You do not need to be an AARP member to enroll in an AARP Medicare Complete plan.
In this article we will discuss:
- What you should know about Medicare Advantage plans
- The three types of AARP Medicare Complete plans offered (HMO, HMO-POS, and PPO)
- How to choose a Medicare Advantage plan
Medicare Advantage plans are a type of Medicare plan offered through private insurance carriers. These sponsors are certified by the Center for Medicare Services (CMS). Typically, Advantage plans include “Original Medicare” Parts A & B, and combine them with a Part D Prescription Drug plan.
|Original Medicare—Parts A&B||HMO—Part C/Medicare Advantage||PPO—Part C/Medicare Advantage|
|What do you pay?||Part B premiums, deductibles, and coinsurances||Medicare premiums and plan premium. Deductibles and copays determined by plan||Medicare premiums and plan premium. Deductibles and copays determined by plan|
|Can you go to a doctor?||Yes, if Medicare is accepted||Must go in-network||Yes, to minimize cost stick to in-network, but can go out of network if needed for higher copay|
|Where do you get routine, non-emergency care?||Anywhere||Local geographic area||Local geographic area|
|How do you get prescription coverage?||Part D||Must join a plan that includes drug covers, Medicare Advantage – Part D||Must join a plan that includes drug covers, Medicare Advantage – Part D|
|Do you need a referral to see a specialist?||No||Usually||No, but you pay more out of pocket if going to a specialists out-of-network|
|Out-of-pocket spending limit?||No||Yes, Medicare Advantage plans have a max on out-of-pocket spending||Yes, Medicare Advantage plans have a max on out-of-pocket spending|
|Do these plans pay for extras, like hearing aids and/or vision?||No||Potentially; some plans have additional benefits available||Potentially; some plans have additional benefits available|
There are three types of AARP Medicare Complete plans to choose from: HMO, HMO-POS, and PPO plans. It is important to know the differences between these three offerings before deciding on the best plan that meets your particular situation.
HMO – Lower Premiums
HMO stands for Health Maintenance Organization. An HMO has a greater emphasis on preventive care than other types of healthcare plans, thus the name Health “Maintenance” Organization. With an HMO, there is a network of physicians and hospitals which an insured individual (known as a “Member”) chooses from, and that chosen physician becomes your primary care provider (PCP). These physicians agree to provide services to Members and receive a monthly payment from the insurance company for each Member that selects them as their PCP.
HMO plans generally have lower monthly payments, also known as monthly premiums. This is because, in exchange for paying lower premiums, you are restricted to only using doctors and specialists who are providers in the HMO network. Receiving care from a physician who is not part of the HMO can mean partial or no reimbursement, or a dramatically reduced reimbursement for expenses you incur.
The restriction to using only HMO network providers is one of the perceived negatives of an HMO plan, as you generally need referrals from their PCP to see a specialist. As previously mentioned, seeing a specialist without a referral may result in out-of-pocket expenses. However, when you are referred by your PCP to a specialist, the usual result is an appointment scheduled quicker and sooner compared to if you did not have a referral.
HMO POS – Out-of-Network is OK
A variation of the HMO plan is the HMO POS plan. In this instance, POS stands for Point of Service. A POS plan has a more flexible network than the regular HMO plan and allows Members to find care outside of the HMO network. You may receive some benefit when seeing an out-of-network physician under certain circumstances, or for certain treatments that are covered by the POS plan.
With a POS plan, it is normally not required to get a physician referral to see a specialist, though a referral may help you see a specialist sooner.
The HMO and POS portions of the plan also carry separate deductibles. The deductibles cannot be combined; each one must be met separately.
PPO – See Who You Want, When You Want…As Long As The Provider Is In-Network
Another plan offered by AARP Medicare Complete is a PPO plan. In this case, PPO stands for Preferred Provider Organization. It differs from an HMO plan in a number of ways.
With a PPO plan, you do not have to select a PCP when enrolling for the insurance coverage. When you need to see a doctor, you select any provider who is in the physician network, also known as an in-network provider. Similarly, when you need to see a specialist, no referral is needed from a physician. You simply makes the appointment and visit the selected specialist.
In certain instances, you may wish to see a physician or specialist who is out-of-network. In most cases, there is some coverage provided for the visit or a performed procedure. While no referral is needed to see the out-of-network provider, you will incur a larger expense.
The flexibility to see whatever doctor you want, whenever you want that PPO plans offer comes with higher monthly premiums than HMO plans.
Neither type of plan is inherently better than the other; it comes down to the preference of cost versus flexibility. The difference in benefits normally is greatest when you see an out-of-network provider.
Individuals who travel extensively need to carefully consider which plan provides the best coverage when they are away from home. HMOs and PPOs will have in-network providers out of your area of residence.
An HMO POS plan may be a good choice if you spend considerable time outside of the area that your PCP covers. As previously mentioned, POS plans provide greater out-of-network benefits than a straight HMO plan will. PPO plans are generally thought to have better coverage outside of your home network.
When considering which plan is right for you, it is best to spend time reviewing coverage and benefits with a licensed insurance agent. Licensed insured agents are trained to understand all of the AARP Medicare Complete plans and can provide guidance as to which plan type will best serve your needs.
More About AARP and UnitedHealthcare
It’s important to know who you’re working with and giving your hard-earned money to. AARP endorses AARP Medicare Complete Plan C programs. UnitedHealthcare underwrites and issues these insurance plans. Let’s take a look at both organizations.
AARP once stood for American Association of Retired Persons; however, it is now simply AARP. The organization now boasts more than 38 million members of all ages. It was founded in 1958 and was initially formed to strictly serve retirees. That is no longer the case. Many of its members are still working and have joined AARP because of the many benefits and discounts offered to members.
One of the major activities of AARP is its lobbying efforts. As baby boomers age, AARP has become their voice on important matters, such as Social Security cost of living increases, and Medicare reform. These are important issues for its members, and it is generally thought by its members that AARP represents them well.
Information on AARP can be found at www.aarp.org, On their website they say, “AARP is a nonprofit, nonpartisan organization that empowers people to choose how they live as they age.” AARP is known for more than its discounts for members. The website offers many resources, with most of them geared toward older members. Much of the content deals with issues such as medications, illness prevention, and aging.
UnitedHealthcare is the company that provides the insurance plans for AARP members. UnitedHealthcare is well known and highly thought of by their policyholders for having knowledgeable insurance agents available to answer questions, as well as a capable customer service group.
It is important that an insurance company have substantial size and financial resources to be able to pay all of the claims submitted each year. Since 1977, UnitedHealthcare has provided its insureds with the financial strength to cover all of its obligations. It is for that reason that over 115 million Americans have chosen UnitedHealthcare to provide the insurance coverage they need. Having complete coverage is important, particularly when someone has worked hard over the years; these hard workers deserve a company with the size and financial strength to cover all of the expenses that have been agreed to be covered.
UnitedHealthcare is well-respected in the business world for being well-managed and financially sound. The Fortune 500 is a famous registry of the 500 largest companies in America, and UnitedHealthcare consistently ranks in the top 25 each year. It is this type of recognition that has led so many Americans to select them for their Medicare plan.
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