Medicare Advantage Plan Networks

Medicare Advantage Plan Networks

Most people I meet have the wrong impression of what a Medicare Advantage plan network is.  Once they hear “HMO” they visualize a network that controls the doctor’s ability to act independently and no access to the best hospitals in Orange County.

The networks that participate in Medicare Advantage plans are an association of physicians in private practice along with hospitals, labs and urgent care centers. These types of networks, even though they are referred to as an “HMO” are very different from the Kaiser/HMO structure.

First, let’s define what a “Network” is.

Medicare Advantage plan networks deal with independent, private-practice physicians that are part of a coordinated network that works together to promote excellence in patient care. There are some really big networks here in Orange County. Most people that live in South Orange County would want to go to the Hoag, Mission, Saddleback, or UCI hospitals. All of these hospitals participate in Medicare Advantage plan networks. When I sit down with someone who is activating their Medicare Part B option for the first time (such as turning 65 or retiring) or looking to enroll in an Advantage plan during the annual enrollment period in the Fall, the first thing I ask is who their primary care physician and specialists are. The majority of the time their physicians are already participating in Medicare Advantage plan networks. (Such as Monarch, MemorialCare , Greater Newport Physicians, the most recently formed network; St. Joseph Hoag Health...just to name a few).

Some are concerned that their doctors will be upset if they go to a Medicare Advantage plan, as if they will be “cheating” their doctor out of something. That is simply not the case. To quote one of the doctors that I work with, “As it turns out, the Medicare HMO capitation is often better for the physician than the fee for service reimbursement”.....Capitation means the doctor gets paid MONTHLY when you enroll in a Medicare Advantage plan and have them listed as your primary care physician. They get paid whether they see you or not! If you use Original Medicare (with or without a Medicare Supplemental plan), they ONLY get paid when they see you! So for most doctors, a balanced “book of business (patients)” makes a lot of sense for them economically.

If you are turning 65 or retiring anytime in the near future, please call to schedule a no-fee consultation, it costs you NOTHING to enroll in your Medicare plan using my services. You’ll see why hundreds of people faced with the same decision as you feel relieved and happy that they took the time to meet with me.

Stephanie Frisch

Stephanie Frisch is the owner of Insurance 101 and is an independent insurance broker dedicated to helping others make “educated decisions” about their insurance choices when it comes to Medicare, Long-Term Care Planning, The Health Insurance Marketplace-Covered California and Life Insurance. For answers to your questions, or an in-home, no-fee consultation, call (949) 351-2443.