Premium
Do these plans charge a monthly premium?
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Yes
Many charge a premium in addition to the monthly Part B premium.
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Yes
Many charge a premium in addition to the monthly Part B premium.
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No
MSA plans don’t charge a premium, but you must continue to pay your Part B premium.
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Yes
These plans usually charge a premium in addition to the monthly Part B premium.
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Yes
Many charge a premium in addition to the monthly Part B premium.
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Drugs
Do these plans offer Medicare prescription drug coverage (Part D)?
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Usually
If you join an HMO plan that doesn’t offer drug coverage, you can't get a separate Medicare drug plan.
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Usually
If you join a PPO plan that doesn’t offer drug coverage, you can't get a separate Medicare drug plan.
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No
If you join a separate MSA plan and want Medicare drug coverage, you’ll have to join a separate Medicare drug plan.
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Sometimes
Prescription drugs may be covered. If your PFFS Plan doesn’t offer drug coverage you’ll need to join a separate Medicare drug plan (Part D) to get drug coverage.
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Yes
All SNPs must provide Medicare prescription drug coverage (Part D).
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Providers
Can I use any doctor or hospital that accepts Medicare for covered services?
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Sometimes
You generally must get your care and services from doctors, other health care providers, or hospitals in the plan’s network (except emergency or urgent care or out-of-area dialysis). In an HMO Point-of-Service (HMOPOS) Plan you may be able to get some services out of network for a higher copayment or coinsurance.
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Yes
Each plan has a network of doctors, hospitals, and other health care providers that you may go to. You may also go out of the plan’s network, but your costs may be higher.
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Yes
MSA plans generally don’t have network providers. You can get covered services from any Medicare provider in the U.S. or U.S. territories.
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Yes
You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan’s payment terms and agrees to treat you. If the plan has a network, you can use any of the network providers, but if you go to an out-of-network provider that accepts the plan’s terms, you may pay more.
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Varies by plan
Some SNPs require that you get your care and services from providers and facilities in the plan’s network (except for emergency care, out-of-area urgent care, or out-of-area dialysis).
However, some SNPs do offer out-of-network coverage, so you can get services from any qualified provider or facility, but you’ll usually pay more.
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