Medicare Advantage Plans

Medicare Advantage plans were created along with the Medicare drug benefit as a result of the 2003 Medicare Modernization Act. The plans are funded by Medicare but design and administration are carried out by private-sectorinsurers.

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have rules for how you get services (like a referral or specific doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care).

Eligible Medicare beneficiaries enroll with an MA by signing on with a agent of the insurer. Anyone under Medicare Advantage can switch back to original Medicare between January 1 and March 31. Medicare requires a release from the insuring company before accepting back someone from an MA plan. Contact your MA plan to learn about their requirement before releasing coverage.

It's important to review the differences between the types of plans to see which works best for you. There are several different types of Medicare Advantage Plans:

HMO ( Health Maintenance Organization Plan)

HMO (Health Maintenance Organization Plan) - allows you to see doctors and other health professionals that participate in its network. If your doctor is already in that network, it could be a good option because you tend to pay less out of your own pocket with network doctors.

PPO ( Preferred Provider Organization Plan)

PPO (Preferred Provider Organization Plan) - gives you the freedom to choose any doctor, which can work for you if you prefer that kind of flexibility.

Private Fee-For-Service Plan

PFFS (Private Fee-for-Service Plan) - pays a specific amount for health care services and the treating doctor has to accept that amount - even if it is less than his or her usual charge. If the doctor does not agree to those terms, then Medicare will not cover services through that doctor.

San Mateo Physical Therapy Center

Special Needs Plans

SNP (Special Needs Plans) - is especially for people who have - as its name implies - special needs. That includes (but is not limited to) those living in a nursing home, Medicaid-eligible individuals, and people with chronic diseases or disabling conditions.

Point of Service Plan

POS (Point of Service Plan) - covers both in- and out-of-network health services, but at different rates. You pay less out of pocket when you go to in-network doctors, labs, hospitals and other health care providers.

Medical Savings Account Plan

MSA (Medical Savings Account Plan) - includes both a high deductible and a bank account to help you pay that deductible. The amount deposited into the account varies from plan to plan. The money is tax free as long as you use it on IRS-qualified medical expenses, which includes the health plan's deductible.

CareAdvantage - Health Plan of San Mateo

While you are a member of CareAdvantage HPSM, you must use your membership card for our plan whenever you get any services covered by CareAdvantage and for prescription drugs you get at network pharmacies. Here’s a sample membership card to show you what yours will look like:campus physical therapy

As long as you are a member of CareAdvantage you must not use your red, white, and blue Medicare card to get covered medical services (with the exception of routine clinical research studies and hospice services). Keep your red, white, and blue Medicare card in a safe place in case you need it later.

Here’s why this is so important: If you get covered services using your red, white, and blue Medicare card instead of using your CareAdvantage membership card while you are a CareAdvantage member, you may have to pay the full cost yourself.