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A Preferred Provider Organization (PPO) is a type of Medicare Advantage plan that
allows you to see in-network doctors or out-of-network doctors. Member cost-sharing
may be higher when plan benefits are received from out of network providers, except
in an emergency.
A Health Maintenance Organization (HMO) is a type of Medicare Advantage plan that
requires you to choose a primary care physician from a network of approved healthcare
providers. If you need to see a specialist, you must have a referral from your primary
care doctor. You must use plan providers except in emergency or urgent care situations
or for out-of-area renal dialysis or other services. If you obtain routine care
from out-of-network providers neither Medicare nor ADVANTAGE Health Solutions will
be responsible for the costs.
The ADVANTAGE Special Needs Plan is a Health Maintenance Organization (HMO) designed for
individuals who qualify for both Medicare and Medicaid. As a member of an HMO, you must
use plan providers except in emergency or urgent care situations, or for out of area renal
dialysis. If you obtain routine care from out of network providers, neither Medicare nor ADVANTAGE
will be responsible for the costs. If you are currently responsible for Part B premiums (based
on your category of Medicaid coverage), you must continue to pay these premiums.
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