Medicare contracts provide health plans of these types:
To being with are the HMO and the Local PPO to provide Medicare benefits. The account of HMO for Medicare Advantage plans enrolment was 63% in 2017 as the majority and the same was 26% for the local PPOs.
The PPOs Regional provides greater access to rural beneficiaries and they cover multi-state or state wide regions. The PPOs regional as per 2017 account in all for 7% as enrollees for Medicare Advantage plans.
Other Types of plan
Apart from the Medicare Advantage Plans PPOs and HMOs, there are other plan types. Fortunately, the enrolment in all other types of plan is low. The account plan for the PFFS types have around 0.2 million enrolled in 2017 or it can be estimated as 1% of all the enrollees. While there are beneficiaries around 0.7 million enrolled in PACE plans, MSA accounts, pilots and demonstrations together accounting to private plan enrolment of 3%.
SPNs are HMOs typically and have limitations to beneficiaries if they are eligible dually for Medicaid and Medicare. They live in institutions as long-term care or require some care in the institutional level or if they have critical conditions. Around 2.3 million beneficiaries in 2017 got enrolled in SNPs and this accounts for 83% in SNPs enrolment for dual eligibility of the total SNPs enrolment.
Payments to Medicare Plans
Medicare Advantage plans receive from Medicare a capitates amount per enrollee to provide the benefits of Part A and B. apart from this, Medicare also makes a payment to plans separately to provide the benefits of prescription drug under Part D Medicare.
Provider Networks Medicare Advantage
Medicare Advantage plans include a list or set of physicians for its 26 medical specialties, along with hospitals, plus chiropractic care and other providers for a particular driving time and enrollees distance to ensure that the enrollees of Medicare Advantage plans receive access to the physicians they require. The network of Medicare Advantage plans comprise of 51% hospitals and 46% physicians in a county on an average and this means the enrollees of Medicare Advantage plans have one-third access and this shows the network of physicians is narrow.
Benefits of Prescription Drug and supplements
The AARP Medicare plans found at https://www.medicareadvantage2019.org/aarp-medicare-advantage-plans-2019/ provide Medicare benefits of all types. Besides they limit spending for services as out of pocket that is covered in Parts A and B Medicare to $6700. The enrollees of Medicare Advantage in 2017, for expenses out of pocket on an average was $5219 that is nearly 52% enrollees exceed $5000 in the plans as spending out of pocket.