Qhov sib txawv ntawm Medicare Advantage PPO thiab HMO Cov Kev Npaj Muaj Dab Tsi?

Zoo Siab

• Medicare Advantage PPO yog dab tsi?
• Yuav ua li cas nws ua haujlwm
• Dab tsi nws npog
• Cov nqi nruab nrab
• Lwm yam nqi
• Medicare Advantage HMO yog dab tsi?
• Yuav ua li cas nws ua haujlwm
• Dab tsi nws npog
• Cov nqi nruab nrab
• Lwm yam nqi
• PPO thiab HMO cov lus sib piv
• Yuav txiav txim siab qhov twg zoo dua rau koj
• Cov muab kev pabcuam
• Cov kev pab cuam
• Cov nqi
• Qhov Txaj Muag
• Cov nqa mus

Medicare Advantage (Tshooj C) yog qhov kev xaiv Medicare uas nrov rau cov neeg tau txais txiaj ntsig uas xav tau tag nrho lawv cov kev pab them nqi kho mob Medicare hauv ib hom phiaj xwm kho mob. Muaj ntau hom phiaj xwm Medicare Advantage, suav nrog Cov Koom Haum Saib Xyuas Kev Noj Qab Haus Huv (HMOs) thiab Cov Chaw Pabcuam Uas Xav Tau (PPOs).

Ob lub HMO thiab PPO cov phiaj xwm cia siab rau siv cov neeg muab kev koom tes ua ke. Txawm li cas los xij, PPO cov phiaj xwm muab kev hloov tau yooj yim los ntawm qhov npog cov kws khomob tawm ntawm cov koom nrog tus nqi ntau dua. Kuj tseem yuav muaj qee qhov sib txawv hauv qhov muaj, kev tiv thaiv, thiab tus nqi nruab nrab ntawm ob hom phiaj xwm.

Hauv tsab xov xwm no, peb yuav tshawb xyuas qhov sib txawv ntawm Medicare Advantage PPO thiab HMO cov phiaj xwm thiab yuav txiav txim siab seb hom phiaj xwm twg thiaj yog qhov zoo tshaj plaws rau koj cov kev xav tau.

Medicare Advantage PPO yog dab tsi?

Medicare Advantage PPO cov phiaj xwm muab qee qhov chaw muab kev hloov yooj yim rau cov uas xav tau nws, tab sis ntawm tus nqi ntau dua.

Yuav ua li cas nws ua haujlwm

PPO cov phiaj xwm pab them rau ob leeg nyob hauv pab pawg thiab cov koom tes sab nrauv, kws kho mob, thiab tsev kho mob. Koj yuav them tsawg dua rau cov kev pabcuam los ntawm cov kws khomob koom tes nrog thiab ntxiv rau cov kev pabcuam los ntawm cov kws khomob sab nrauv. Raws li phiaj xwm PPO, xaiv ib tus thawj kws kho mob (PCP) tsis tas yuav thiab tsis tas xa mus rau cov kws kho mob tshwj xeeb.

Dab tsi nws npog

PPO cov phiaj xwm kho mob feem ntau them rau tag nrho cov kev pab cuam uas Medicare Advantage cov phiaj xwm duav tau, suav nrog:

• pov hwm tsev kho mob
• pov hwm kho mob
• Kev pab them tshuaj

Yog tias koj tau txais kev kho mob hauv tsev kho mob lossis kev kho mob raws li PPO txoj kev npaj, siv cov kws kho mob hauv koom tes tuaj yeem pab koj kom tsis txhob them tus nqi ntau dua. Vim tias txhua qhov Medicare Advantage PPO cov kev pab them nqi sib txawv, koj yuav tsum tshawb nrhiav cov phiaj xwm tshwj xeeb uas muaj hauv koj thaj chaw kom paub meej txog lwm yam uas muaj nyob hauv txhua daim phiaj.

Cov nqi nruab nrab

Medicare Advantage PPO cov phiaj xwm muaj cov nqi nram qab no:

• Tus nqi npaj them hom phiajCov. Cov nyiaj them nqi no tuaj yeem yog txij $ 0 txog rau tus nqi nruab nrab ntawm $ 21 toj ib hlis nyob rau xyoo 2021.
• Tshooj B hwmCov. Xyoo 2021, koj cov nuj nqi B yog $ 148.50 tauj ib hlis lossis siab dua, nyob ntawm koj cov nyiaj tau los.
• Hauv-tawm hauv txoj kev them tawmCov. Tus nqi tes no feem ntau yog $ 0 tab sis yuav siab txog $ 500 lossis ntau dua, nyob ntawm hom kev pab twg koj nkag rau.
• Cov tshuaj txiav tawmCov. Cov nyiaj txiav tawm no tuaj yeem pib ntawm $ 0 thiab nce ntxiv nyob ntawm koj li phiaj xwm PPO.
• Cov Nqi ThemCov. Cov nqi no yuav txawv nyob ntawm seb koj puas ntsib tus thawj kws khomob lossis tus kws khomob tshwj xeeb thiab yog cov kev pabcuam ntawd nyob hauv nevvawj lossis sab nrauv.
• Tuam Kho MobCov. Qhov nqi no ib txwm yog 20 feem pua ​​ntawm koj cov nuj nqis uas Medicare-pom zoo tom qab koj them tawm.

Tsis zoo li Medicare qub, Medicare Advantage PPO cov phiaj xwm tseem muaj qhov siab tshaj plaws ntawm hnab nyiaj. Tus nqi no nws txawv tab sis feem ntau nyob hauv ib nrab-txhiab.

Lwm yam nqi

Nrog rau lub phiaj xwm PPO, koj yuav tshuav tus nqi them ntxiv rau qhov pom sab nraum cov kws kho mob sab nrauv. Qhov no txhais tau hais tias yog koj xaiv PCP, mus saib tsev kho mob, lossis mus nrhiav kev pabcuam los ntawm cov chaw khomob uas tsis nyob hauv koj li PPO, koj yuav tau them ntau dua li tus nqi nruab nrab uas tau teev tseg saum toj no.

Medicare Advantage HMO yog dab tsi?

Medicare Advantage HMO cov kev pab them nqi tsis muab kev yooj yim rau cov muab kev pab, zam rau cov xwm txheej kho mob ceev.

Yuav ua li cas nws ua haujlwm

HMO txoj kev pab them nqi kho mob nyob rau hauv cov koom tes, kws kho mob, thiab tsev kho mob nkaus xwb, tshwj tsis yog kev kho mob ti tes ti taw lossis kev kho mob maj nrawm nyob sab nraum thaj chaw thiab lim ntshav. Muaj qee kis, koj kuj tseem tuaj yeem siv cov muab kev pabcuam tawm sab nrauv, tabsis koj yuav them 100 feem pua ​​ntawm cov kev pabcuam koj tus kheej.

Nyob rau hauv HMO txoj kev pab them nqi, koj yuav tsum xaiv PCP hauv-network thiab koj tseem yuav tsum tau xa kom mus ntsib kws kho mob hauv koom tes.

Dab tsi nws npog

Zoo li PPO cov phiaj xwm, HMO cov phiaj xwm duav tau tag nrho cov kev pab uas Medicare Advantage cov phiaj xwm feem ntau duav, suav nrog:

• pov hwm tsev kho mob
• pov hwm kho mob
• Kev pab them tshuaj

Thaum koj mus nrhiav kev pab hauv tsev kho mob lossis kev kho mob, koj yuav tsum xaiv cov npe ntawm cov kws khomob koom tes nrog uas koj lub HMO hom phiaj yuav duav tau. Yog tias koj mus nrhiav cov kev pabcuam sab nraud koj cov phiaj xwm nyob hauv cov npe koom nrog, koj yuav tsum tau them tas tus nqi rau cov kev pabcuam ntawd.

Txawm li cas los xij, thaum muaj xwm txheej ceev, xws li thaum mus ncig, koj yuav raug them raws li cov lus tshwj xeeb ntawm koj txoj kev npaj khomob.

Cov nqi nruab nrab

Medicare Advantage HMO cov phiaj xwm muaj cov nqi pib ib yam li PPO cov phiaj xwm, suav nrog cov phiaj xwm txhua hli thiab Tshooj B cov nqi them, txiav tawm, thiab them nyiaj thiab cov nqi them. Raws li txoj cai, koj lub HMO txoj kev pab them nqi tseem yuav muaj ib lub hnab nyiaj tshaj rau koj nyob rau ib xyoos.

Lwm yam nqi

Vim HMO cov phiaj xwm xav tau kom koj nrhiav cov kev pab hauv network, feem ntau koj yuav tsis tau them tus nqi ntxiv tshwj tsis yog koj txiav txim siab siv cov neeg muab kev pab tawm sab nrauv. Thaum muaj xwm txheej ceev, koj yuav tau them tus nqi ntxiv, tab sis koj yuav tsum xyuas nrog koj txoj kev npaj saib seb cov nqi no yog dab tsi.

PPO thiab HMO cov lus sib piv

Muaj ntau qhov zoo sib xws ntawm Medicare Advantage PPO thiab HMO cov phiaj xwm, xws li cov nqi ntawm cov nqi them nyiaj, cov nqi txiav tawm, thiab lwm cov nqi npaj. Feem ntau qhov sib txawv ntawm ob hom phiaj xwm tswv yim feem ntau raws li kev pab them nqi thiab cov nqi pabcuam sab hauv thiab sab nraud.

Hauv qab no yog daim qauv piv qhia ntawm txhua qhov phiaj xwm muab ua dab tsi hais txog kev duav thiab cov nqi.

Txawm li cas los xij hom Medicare Advantage hom kev pab koj xaiv, nco ntsoov them rau cov kev xaiv thiab cov nqi pov hwm txuas nrog cov phiaj xwm koj xaiv. Vim tias Advantage cov kev pab them nqi tau los ntawm cov tuam txhab muag kev pov hwm, lawv yuav txawv qhov lawv tuaj yeem muab thiab lawv txiav txim siab them nqi li cas.

Yuav txiav txim siab qhov twg zoo dua rau koj

Xaiv cov phiaj xwm Medicare Advantage zoo tshaj nyob ntawm koj tus kheej kev noj qab haus huv thiab nyiaj txiag. Qhov uas ua haujlwm rau lwm tus neeg yuav tsis ua haujlwm rau koj, yog li nws yog qhov tseem ceeb rau koj tshawb nrhiav cov phiaj xwm hauv koj thaj chaw.

Nov yog qee qhov kev xav txog thaum xaiv seb puas yuav cuv npe hauv PPO lossis HMO Advantage txoj kev npaj.

Cov muab kev pabcuam

Yog tias koj pom tus nqi them rau cov muab kev pab yooj yim, PPO phiaj xwm yuav yog qhov zoo rau koj, vim nws muaj kev pab them nqi rau cov kev pab cuam sab hauv thiab sab nraud. Txawm li cas los xij, qhov no tsuas yog qhov kev xaiv rau koj yog tias koj muaj nyiaj txiag los mus ntsib cov kws kho mob sab nrauv, vim cov nqi kho mob no tuaj yeem sib ntxiv sai.

Yog tias koj tau zoo nrog siv nyob hauv cov network, cov HMO phiaj xwm yuav tso cai rau koj nyob hauv network yam tsis muaj kev cuam tshuam nyiaj txiag ntxiv.

Cov kev pab cuam

Raws li kev cai lij choj, tag nrho cov phiaj xwm Medicare Advantage yuav tsum them tsawg kawg Medicare Part A thiab Ntu B. Ntxiv rau, yuav luag txhua cov phiaj xwm Advantage kuj tseem them rau cov tshuaj, kho qhov muag, thiab kho hniav. Cov kev fajseeb khomob no tau hais meej rau txhua txoj kev npaj khomob, tabsis feem ntau tsis muaj qhov txawv txav ntawm cov kev xaiv kev tiv thaiv ntawm feem ntau PPO thiab HMO Advantage cov phiaj xwm.

Ib qho ntxiv uas yuav tau txiav txim siab yog seb qhov kev pab them nqi uas PPO thiab HMO cov phiaj xwm kho mob puas yuav cuam tshuam los ntawm koj tus mob. Piv txwv li, qhia tias cov neeg muaj kev mob nkeeg feem ntau yuav rho npe tawm ntawm HMO cov phiaj xwm kho mob thiab mus tso npe rau lwm hom phiaj xwm kho mob, xws li.

Cov nqi

Medicare Advantage PPO thiab HMO cov kev pab them nqi kho mob yuav txawv nyob hauv lawv cov nqi nce nyob ntawm seb koj nyob lub xeev twg thiab hom kev pab them nqi dab tsi koj tab tom nrhiav. Tsis muaj teeb meem dab tsi uas koj xaiv, txhua txoj kev npaj nyiaj txiag tuaj yeem them tus nqi them, cov nqi txiav tawm, them tus nqi them, thiab ua kom muaj nuj nqis. Tus nqi ntawm txhua tus ntawm cov nqi no yog nyob ntawm txoj kev pabcuam koj xaiv.

Tsis tas li, txiav txim siab tias yuav muaj lwm cov nqi ntxiv ntsig txog koj txoj kev npaj nyob ntawm seb cov kws kho mob uas koj tau ntsib. Piv txwv li, yog tias koj mus ntsib cov kws kho mob sab nrauv cov koom tes ntawm PPO phiaj xwm, koj yuav tau them ntau dua cov hnab ris rau cov kev pab ntawd.

Qhov Txaj Muag

Medicare Advantage cov kev npaj yog nyob raws qhov chaw, txhais tau tias koj yuav tsum cuv npe hauv lub xeev uas koj nyob thiab tau txais kev kho mob. Qhov no txhais tau hais tias PPO thiab HMO cov phiaj xwm kuj yuav txawv nyob ntawm qhov chaw koj nyob.

Qee lub tuam txhab ntiag tug yuav tsuas muaj ib hom phiaj, thaum lwm tus yuav muaj ntau lub qauv xaiv. Koj nyob qhov twg yuav txiav txim siab txog qhov kev pab them nyiaj muaj, kev pab them nyiaj, thiab cov nqi ntawm hom kev pab Medicare Advantage uas koj xaiv.

Cov nqa mus

Medicare Advantage PPO thiab HMO cov phiaj xwm yog qhov kev xaiv kev pov hwm zoo rau cov neeg uas xav tau kev pab them nqi kho mob Medicare raws li ib qho kev pab them nqi.

Thaum muaj qhov sib xws ntawm ob hom kev npaj, kuj tseem muaj qhov sib txawv hauv kev muaj, kev tiv thaiv, thiab tus nqi. Thaum xaiv qhov zoo tshaj plaws Medicare Advantage qauv qauv rau koj, nco ntsoov txiav txim siab txog koj cov chaw muab kev pab xav, nyiaj txiag, thiab kev kho mob xav tau.

Thaum twg koj npaj tau los xaiv Medicare Advantage txoj kev pab them nqi kho mob, mus saib Medicare cov phiaj xwm phiaj xwm nrhiav cov ntaub ntawv rau cov ntaub ntawv hais txog cov phiaj xwm hauv koj cheeb tsam.

Kab lus no tau raug hloov kho thaum Lub Kaum Ib Hlis 17, 2020, kom pom zoo 2021 cov ntaub ntawv Medicare.

Cov ntaub ntawv ntawm lub vev xaib no tuaj yeem pab koj txiav txim siab tus kheej txog kev tuav pov hwm, tab sis nws tsis yog yuav pab tswv yim txog kev yuav khoom lossis kev siv cov khoom pov hwm lossis kev tuav pov hwm. Healthline Media yuav tsis hloov lag luam ntawm kev tuav pov hwm tsis hais yam twg thiab tsis tau ntawv tso cai raws li cov tuam txhab pov hwm lossis cov neeg tsim khoom hauv ib cheeb tsam ntawm Teb Chaws Asmeskas. Healthline Media tsis tau qhia lossis pom zoo rau ib tog neeg thib peb uas ua lag luam ntawm kev tuav pov hwm.