Insurance
Prescription Drug Benefit Programs
With the rising costs of prescription drug costs, the demand for prescription drug benefits has increased. Many prescription drug benefit programs have been formed recently to try to meet this demand, including the Medicare Prescription Drug Benefit Program. Seniors have become overwhelmed by the large number of prescription drug benefit programs available and the complexity of some of these programs coupled with the mixed messages in the media about whether these programs are good for seniors has lead to confusion. The Area Office on Aging of Northwestern Ohio has developed a prescription drug benefit comparison chart that simplifies the process of finding out what prescription drug benefit program is best for you. To view the prescription drug benefit chart, please click here.
Health Maintenance Organizations (HMO’s)
HMO’s are owned and operated by insurance companies. HMO’s contract with selected doctors, hospitals, and other providers that accept HMO agreed fees for services. Members have limited choices in selecting providers, however, costs may be lower than traditional Medicare deductible and coinsurance amounts. Provisions and rules are subject to change.
Preferred Provider Organizations
(PPO’s)
PPO’s are operated by a group of doctors and hospitals. PPO’s contract with an insurance company to provide medical services at discounted fees. PPO members can use outside providers for an additional fee. PPO’s don’t usually offer as wide a spectrum of health care services as HMO’s.
Providers Sponsored Organizations
(PSO’s)
PSO’s consist of a group of medical providers (doctors and hospitals) who form their own network. PSO’s are operated by a group of medical providers rather than an insurance company. Medical care is provided at a fixed amount.
Private Fee-For-Service Plans
Medicare makes fixed monthly payments to the private plans. Private plans offer the same coverage as Part A and Part B under traditional Medicare. Plans may also offer supplemental benefits. Beneficiary would purchase this private indemnity insurance policy.
Medical Savings Accounts (MSA’s)
Participants can select a high deductible insurance policy in combination with a medical savings account. A high deductible (up to $6,000) must be met. Funds are used to pay for the cost of medical services up to the plan’s deductible.
Medicare Advantage
- Medicare managed care plans, which are similar to HMOs, and
- Medicare Private Fee-For-Services plans.
The Ohio Department of Insurance's Ohio Senior
Health Insurance Information Program (OSHIIP) has created a one-stop
educational resource center to help Medicare beneficiaries make more
informed decisions when deciding on prescription drug discount card
programs and to help Medicare beneficiaries better understand recent
changes made to Medicare.
Questions regarding specific health care plans and these decisions can
be directed to OSHIIP 1-800- 686-1578
