A Medicare Advantage Plan is a kind of Medicare health plan, and this is offered by a private company that will provide you with all your Part A and B benefits. These kinds of Medicare plans have grown in popularity in the last ten years, with almost 10 million seniors already covered by them. Medicare Advantage Plans include a number of managed care plans, Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) plans, being the most popular.

1. Medicare
Advantage Plans:
HMO And PPO Basics
Keystone 65 Page 1

2. A Medicare Advantage Plan is a kind of Medicare health plan, which is available
through a private company that will serve you your complete Part A and B
benefits. These kinds of Medicare plans have grown in popularity in the past
decade, with almost ten million elderly individuals already enrolled in them.
Medicare Advantage Plans include many managed care plans, Health
Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO)
plans, being two of the most widely used.
What is a Health Maintenance Organization plan?
In an HMO plan, you can only go to doctors and other providers of medical
services that are on the plan's list, except when it is for an emergency or out-of-
area urgent care and dialysis. HMOs require that you select a primary care
physician who will manage and coordinate all of your health care. This means, if
you require care from a specialist, your primary care physician will provide you
with a referral.
What is a Preferred Provider Organization plan?
In contrast to HMO plans, you can receive your health care from any doctor, other
healthcare service providers or hospitals if you enrolled in a PPO plan. In this type
of plan, you pay less if you use providers that belong to the plan’s network, and
you pay more if you obtain services outside of the network. There is no need to
select a primary care doctor, and you don’t have to get a referral to receive care
from a specialist. In most cases, these plans also provide prescription drug
coverage.
Keystone 65 Page 2

3. Which one is right for me?
It all depends on your preferences. If you have more peace of mind from having a
primary care provider to manage and coordinate your care, then an HMO plan
like Keystone 65 is a better choice, but if
you prefer more versatility, choose a PPO
plan.
When am I eligible to enroll for a
Medicare Advantage health plan?
You can enroll in a Medicare Advantage
plan during the 7 month interval
starting3 months before you turn 65up to
3 months after you turn 65. If you have a
disability but you're not yet 65, you can also enroll during the 7 month period
which starts from three months before your twenty-fifth month of being given
Social Security disability benefits up to three months after that. Each year, you
will also be able to to make modifications to your Medicare Advantage plan
between October 15 to December 7.
Keystone 65 Page 3