Types of Medicare Advantage Plans - Essay Example

The perceived downside of HMO is that you have to choose your doctor and other health providers in your HMO network. You can be restricted in your choices.
PPOs, or Preferred Provider Organizations, like HMOs, have pre-approved lists of healthcare providers. Like HMOs, this type of Medicare Advantage Plan allows for the insured to choose from doctors and other healthcare professionals outside of this network. However, this plan cost you more in deductibles, co-insurance, and other out-of-pocket expenses. In this plan, when you use a non-participating provider you will be paying more for that privilege.

A Point-of-Service plan or POS is a bit like a combination of the HMO and PPO. Like the HMO, you must select your doctor or primary physician but can also have the choice to go out of your network like in a PPO. If you stay within a network like HMO, your copayment and deductibles are small.

Medicaid agencies and HMO
There is a growing popularity of Medicaid contracting with HMOs because this type of plan offers Medicare recipients the most minimal out-of-pocket expenses and low or zero monthly premiums. Because of this, more Medicaid agencies prefer to contract with HMO plans. Patients and beneficiaries prefer HMOs because of the low cost. Any Medicaid agency will prefer to provide what patients want. Since HMOs provide preventive measures, Medicaid agencies can save more cost than use that doesn’t have preventive measures service. This is one of the reasons why they can get more value for their money. There are fewer hospital patients because of these measures.

According to the Wall Street Journal, many states are moving progressively to place more Medicaid beneficiaries in HMOs and more than one in three beneficiaries receive through a private insurer (Profits Grow For Medicaid HMOs As Physicians, Patients Criticize Coverage Restrictions, 2006). Because of this, there is a rapid growth in some companies who contracted with Medicaid. There were nearly 1.2 million members from Medicaid and $ 1.5 billion in revenue in 2005. In 1999, there were only 142,000 members and about $200 million in revenue (Profits Grow for Medicaid HMOs as Physicians, Patients Criticize Coverage Restrictions, 2006). With this rapid growth of plan holders, Medicaid can surely get earn profits, especially with the preventive measures available in HMOs.