Which one is right for me? If you want low monthly premiums and copays and you don’t travel much, an HMO plan might be right for you. If you do a lot of traveling within the U.S. and you want the convenience of having one doctor coordinating all your care, an HMO-POS plan might be right for you. If you want to be able to coordinate your own health care and see specialists without a referral, a PPO plan might be right for you. All our Medicare Advantage plans help cover emergency care outside the U.S.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
In Pittsburgh Pennsylvania 15236 PPO plans have more flexibility than HMO plans. You don’t need a primary care physician, and you can go to a specialist directly. You don’t need referrals. You can see doctors inside or outside your network. But if you stay in your network, you’ll pay less.
Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
To take full advantage of the savings available with your benefits, choose a doctor within your network for routine care. With the exception of emergencies and urgent care situations, it may cost more for covered services received outside the network.
You might need to take a more active role in care coordination in a PPO plan. For example, if you see providers outside the Medicare Advantage PPO plan’s network, you may have to give information about the medical care you have received and your prescription drugs to doctors who treat you.
Medicare Advantage Health Plans are very affordable Medicare Advantage plans (medical-only and medical plans with prescription drugs) in Pittsburgh PA 15236 Allegheny county. Compare plan types below to view coverage details to see which one best meets your needs. You may enroll in a Medicare Advantage Plan during the annual election period, during a special election period, or during your initial election period.
With a Medicare PPO, you are free to visit the health care provider of your choice. The PPO plan will have a network of providers (similar to as with an HMO plan), and you will typically have lower out-of-pocket costs if you stay within that network.
With numerous standard combined medical and prescription drug plan designs to choose from, it’s likely you will find one that suits your organization’s needs. If not, we can create custom plans for larger groups.
You’re covered for unlimited medical doctor visits with affordable copayments, so you can see the PCP you choose as often as you need. Plus, you’re not locked in once you pick your doctor. You can change to a different in-network doctor whenever you like.
If you’ve been shopping for Medicare Advantage plans, you’ve probably noticed a lot of acronyms. HMO, POS, PPO, PFFS – all of these signify different plan types. We’ll spell it out for you. HMO stands for health maintenance organization. POS stands for point of service. PPO stands for preferred provider organization. PFFS stands for the private fee for service. All these plans use a network of doctors and hospitals. The difference is how big those networks are and how you use them. HMO plans Navigating the health care industry on your own can be complicated. There are lots of doctors out there. And it’s hard to know which ones will be the right fit for you. At times, you might feel like you’re the only one advocating for your health. HMO plans help with that. When you have an HMO plan, you choose a primary care physician who works as your partner. They coordinate all your care and refer you to trusted doctors and specialists in your network. Here’s an example of how an HMO plan works.
You have to live in the Pittsburgh PA 15236 Allegheny county, for at least six months out of the year to get one of our HMO-POS plans. You can read more about Blue Card and getting care while traveling in our Help Center. PPO plans PPO plans have more flexibility than HMO plans. You don’t need a primary care physician, and you can go to a specialist directly. You don’t need referrals. You can see doctors inside or outside your network. But if you stay in your network, you’ll pay less. Here’s an example of how a PPO plan works.