INSURANCE Laura Mutsko Mutsko Insurance Services, LLC

Laura Mutsko Agent, CSA and Certified Healthcare Reform Specialist

Q: I am thinking of switching from Original Medicare to a Medicare Advantage Plan for 2018. Please explain the difference between an HMO and a PPO? A: The two types of Advantage plans you hear about most often are HMO and PPO plans. Generally speaking, the differences between HMO and PPO plans are the size of the plan network, ability to see specialists, plan costs, and coverage for out-of-network services.

Here are other key points: HMO is short for Health Maintenance Organization.

Generally, HMOs tend to be among the more affordable choices. They usually have zero or a low monthly premiums and low deductibles. Except for emergencies, HMOs do not cover care you receive outside their network. If you have a doctor you want to keep seeing or a preferred hospital, it is important to make sure these are in the provider network of any HMO you are considering. You may also have to choose a primary care physician (PCP) in the plan network who will provide general medical care and authorize referrals to in-network specialists. HMOs can be a good choice as long as the doctors, hospitals and other health care providers you prefer are in the HMO’s network. PPO is short for Preferred Provider Organization.

PPO plans offer greater flexibility than HMOs, usually having a larger network of physicians, hospitals and other health care providers. An important difference is that unlike an HMO, you can see providers outside the network for any service at any time, as long as they accept Medicare and you’re willing to pay more out-of-pocket. With some PPOs you may need to pay the non-network doctor directly, and then file a claim for partial reimbursement. Premiums tend to be higher for a PPO and it is common to have a deductible. Some other points to consider: • Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you’ll pay nothing for covered services. With Original Medicare you are responsible for 20% of the cost for doctors and other medical services with no annual limit.

• Prescription coverage (Part D) is included with many HMO and PPO plans. Part D coverage must be purchased separately with Original Medicare. • HMOs and PPOs often provide additional benefits not offered by Original Medicare including gym memberships, dental, vision, hearing and podiatry care.

It is a good idea to get started now learning about your Medicare choices. Open Enrollment begins on October 15. If you have questions or would like to compare Medicare plans, give me a call at 440-255-5700 or email me at Lmutsko@mutskoinsurance.com. We will set up a time to do a review. 6982 Spinach Drive, Mentor, OH 44060 440-255-5700 www.mutskoinsurance.com