Question 5
Answer:
All of the Anthem SmartValue Private Fee for Service plan options and the Health Net Navy POS plan option are considered Medicare Advantage Plans, however, they work differently in terms of accessing care and in the process in which your covered services are paid.
Under the Anthem SmartValue Private Fee for Service plans, you are able to access care from any provider or hospital in the country that accepts Medicare assignment without a referral. There is not a network of participating physicians or providers. As long as the provider agrees to the terms and conditions of the plan and is willing to bill Anthem or the local BCBS entity in other states other than Connecticut, and therefore accepts your Anthem PFFS ID card, the provider is paid according to the Medicare fee schedule. However, Medicare permits providers to decide to accept or decline participation in these plans on a person by person or visit by visit basis. It is therefore best to check with your doctors prior to enrolling so that you are confident that they will be willing to accept the Anthem SmartValue Private Fee for Service Plan. Our office can assist you with the process should you need our help.
The Navy POS (Point of Service) plan is a little easier in some regard relative to the network issue as the participating provider network is defined. Providers either participate or they do not participate. You should receive a Health Net Medicare Provider Directory directly from Health Net if you reside in the State of Connecticut. If you did not receive a directory, you can get one at our monthly informational meetings in Groton or you can request one by calling our office, the most updated provider information is available on line at the Health Net website at www.healthnet.com. Under the Navy POS plan, you may seek care with any participating provider without a referral. Most services with the exception of emergency and urgent care are covered at no copay when seeking care through a participating provider.
Under Navy POS (Point of Service), you may also visit non-participating providers and those providers will be paid according to the Medicare fee schedule less your applicable copay or cost share. There are some services not covered out of network such as skilled nursing care and outpatient mental health services. Please refer to the summary of benefits in your benefit booklet for details.