Once you become a Blue Medicare HMO or Blue Medicare PPO member, you transfer the administration of your Medicare benefits to Blue Medicare HMO or Blue Medicare PPO. This means you maintain your status as a Medicare beneficiary, plus gain the enhanced coverage available through your Blue Medicare HMO or Blue Medicare PPO health plan. You will receive a Blue Medicare HMO or Blue Medicare PPO Member ID card that you will present when using your Blue Medicare HMO or PPO benefits.

HMO is an alternative to Original Medicare and features specific lists of doctors, hospitals, and other providers that you must use to receive benefits. HMOs often provide additional benefits not found in Original Medicare, including coverage for deductibles, steep reductions in coinsurance when you see a doctor, a drug benefit plan, and wellness or fitness programs. If you select a Medicare Advantage HMO, it is an alternative to your Original Medicare coverage.

With a Medicare Advantage PPO, you can see any doctor you want. However, if you use a doctor who participates in the network, you get a better benefit and lower copayment/coinsurance than if you visit a non-network doctor. Plus, referrals aren’t needed, and you don’t have to see a primary care physician first. In addition to prescription drug benefits, Medicare Advantage PPOs may offer other benefits such as dental, vision, and nutritional supplements.

Between November 15 and December 31 of each year, you can select a new Part D plan. The change will be effective January 1 of the following year. If you didn't join a Medicare prescription drug plan before May 15, 2006, you will pay a higher premium unless you already have drug coverage that, on average, is at least as good as standard Medicare prescription drug coverage (through an employer or union, for example).

No. The Family Healthcare Plan discount cannot be applied if another discount has already been applied from any HMO, PPO, Medicare or other discount plan.

Yes, as long as the physician that you choose accepts your managed care plan. You may verify that the doctor you choose accepts your insurance by calling your doctor's office, visiting the physician’s profile on this web site, calling AccessMD or calling your doctor’s office.

Blue Medicare Rx coverage, which is sometimes referred to as Medicare Part D, is designed to help you by covering prescription drugs at local pharmacies and through mail order. Everyone with Medicare is eligible for this coverage, but the coverage is not mandatory. It is a voluntary program that you may choose to purchase each year. Blue Medicare Rx coverage is insurance. Private companies, like Blue Cross and Blue Shield of North Carolina, provide the coverage.

Participants with Medicare and/or Medicaid authorize Total Community Care to provide services to you. This means that you maintain benefits covered by Medicare and/or Medicaid and become eligible for additional benefits offered by Total Community Care. Individuals who are currently enrolled in an HMO will disenroll in order to join Total Community Care. Our participants live in their own homes, with family members, in assisted living, or in adult family homes.

A PPO (Preferred Provider Organization) plan is a plan where preferred providers of service (including doctors and hospitals) have a contract with an insurance company or a health plan to offer service for their policyholders. Generally, the preferred service provider agreed to accept an insurance company's usual and customary payment. If you have a PPO contract, and do not use the preferred service providers, you may find yourself paying more for services rendered by the physician or hospital.

HMO (Health Maintenance Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses. As a HMO member, you choose a primary care physician (PCP) at the time of enrollment. The PCP will handle most of your healthcare needs. The member must receive a referral from their PCP in order to see a specialist. HMO plans offer a broader range of preventive coverage than most other plans.

Both a Preferred Provider Organization (PPO) plan and a Health Maintenance Organization (HMO) plan use provider networks. Medical providers in both types of plan networks have contracted to provide their services and facilities to plan participants at reduced costs. Participants of a PPO plan have complete freedom in choosing physicians and medical facilities whenever in need of care.

Health insurance companies generally offer a variety of health insurance plans and options. A PPO is generally a health insurance plan which provides increased benefits when you go to participating panel medical providers. An HMO generally requires that the plan member goes to plan providers and pays little or nothing for the visit. Generally visits to no-plan providers are not permitted except in emergencies.

Each plan provider will establish its own formulary, or list of prescription drugs, that it will cover. Although formularies must meet certain requirements set by Medicare, they still differ by plan. Certain medical supplies associated with the injection of insulin (syringes, needles, alcohol swabs and gauze). Certain drugs, or classes of drugs, will not be covered because they are excluded by law, such as over the counter medicines like aspirin.

An HMO is an alternative to Original Medicare and features specific lists of doctors, hospitals, and other providers that you must use to receive benefits. HMOs often provide additional benefits not found in Original Medicare, including coverage for deductibles, steep reductions in co-insurance when you use doctors, a drug benefit plan and wellness or fitness programs. If you select a Medicare Advantage HMO, it replaces your Original Medicare coverage.

With a Medicare Advantage PPO, you can see any doctor you want. However, if you use a doctor who participates in the network, you get a better benefit and lower copayment than if you visit a non-network doctor. Plus, referrals aren’t needed and you don’t have to see a primary care doctor first. In addition to prescription drug benefits, Medicare Advantage PPOs may offer additional benefits such as dental, vision, and nutritional supplements.

Mail in Application:Contact the company offering the drug plan you choose and ask for an application. Once you fill out the form, mail or fax it back to the company. On Medicare's Website: You will also be able to join a drug plan by using Medicare's online enrollment center. By Calling Medicare: You can join a drug plan by calling 1-800-MEDICARE (1-800-633-4227) and talking to a Medicare customer service representative. TTY users should call 1-877-486-2048.

PPO members are not required to stay within the PPO network, but there is usually a strong financial incentive to do so. With NC SmartChoice, State members will save on their medical costs by avoiding deductibles and coinsurance for physician office visits. NC SmartChoice provides choice. State members will have three plan options, with varying levels of coverage to choose from. On the CMM plan, members must choose where to use the $150 wellness benefit.

The primary difference is that HMOs limit your non-emergency health care coverage to a limited network of physicians and hospitals. PPO plans insure covered services delivered by any licensed physician or hospital, though a PPO plan will offer improved benefits if you use physicians and hospitals participating in the PPO's preferred network. PPO networks are normally much larger than HMO networks, though HMOs provide higher benefit levels.

HMO plans typically have a limited network of providers and lower out of pocket costs for services. A primary care physician is usually selected and manages your health care and serves as a gatekeeper for referral to specialty care. PPO plans give economic incentives to patronize certain physicians, laboratories, and hospitals that agree to supervision and reduced fees. You may incur co-payments as well as deductibles, co-insurance, and out-of-pocket maximums for all covered services.

Due to the implementation of the Medicare prescription drug program, as of January 1, 2006, Medicaid no longer pays for most prescription drugs. You will need to join a Medicare prescription drug plan for Medicare to pay for your drugs.

Health insurance companies generally offer a variety of health insurance plans and options. A short term plan generally provides medical insurance benefits for a period of time that is otherwise a gap in coverage. It generally terminates at the end of its term. If is generally not guaranteed renewable, and if renewing is an option, a new medical qualification must generally be satisfied.

The level of benefits and the amount of freedom to choose among physicians and hospitals are usually the two main differences. Benefits are also a key difference deductible, co-insurance, co-pays and networks. See below . . . HMO: Health Maintenance Organization provides very rich benefits - preventive care coverage and low out-of-pocket costs. There is typically no coverage for care from doctors or hospitals outside your HMO plan.

Under SB 840 (Kuehl), seniors get benefits that Medicare doesn't cover, such as full prescription drug coverage and dental coverage. For at least the first two years there will be no co payments or deductibles for ANY services. Seniors will spend less than they do now for health care.

These are the types of questions which we need to help you with. You need to talk with one of our account exec's. Please contact Jodi Beidler and she will put you in touch with the right person. You can call Jodi at 319-557-9981 x20 or call 1-877-468-7426 and ask for Jodi Beidler.

Consider what is most important to you in a health plan: cost, availability and location of providers, or freedom to see any doctor. If you like the physician you are currently seeing, check to see if he or she is a provider in the plan that you are considering. If you or a dependent has special medical needs, check that the plan you are considering has adequate medical services and providers for that specialty.

A special arrangement between an insurer and hospitals, physicians and other health care professionals to pay for health care services, resulting in savings for the insured. PPO coverage does not require you to use a PPO doctor. approach to health care utilizing the Primary Care Physician (PCP) concept. HMOs provide preventive care, such as routine physicals, education, and early intervention to decrease occurrence of disease.

You will have the convenient option of using a mail-order pharmacy. You can purchase up to a 90-day supply through mail order, and your medications will be delivered directly to your home. Depending on your plan, there may be savings available to you if you use the mail option.

On a Health Maintenance Organization (HMO) plan, covered services must be provided or authorized by the member's primary care physician and received from plan (in-network) providers. A referral must be obtained prior to receiving care from specialty providers except for in-network gynecological and obstetrical visits for women and routine eye examinations. Services provided by nonplan (out-of-network) providers are not covered except for emergency care and urgent care.

Most HMOs require you to select a specific doctor as your primary care physician, or PCP. This doctor is supposed to be your first "port-of-call" for most any medical condition, although exceptions are typically made for emergencies. As such, he or she will end up providing most of your medical care.