The Six Types of Medicare Advantage Plans

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The Six Types of Medicare Advantage Plans

 

The Six Types of Medicare Advantage PlansYou can receive Medicare Part A and Part B coverage either through Original Medicare or through a Medicare Advantage plan (Part C). Medicare Advantage plans are offered by private companies approved by Medicare. They provide all of your Medicare Part A and Part B coverage. Many plans also include coverage for extra services (like vision or dental), and most include Medicare prescription drug coverage (Part D). How much you pay and how you access services varies by plan.  

There are six basic types of Medicare Advantage plans. Some types may work better for you than others. Here’s an overview of each to help you begin to learn which type may be right for you. 

1.      Health Maintenance Organization (HMO) Plans

HMO plans are types of managed health care whose purpose is to provide members access to cost-effective, high-quality medical care. An insurance company running an HMO usually creates a “network,” which means that they sign agreements with doctors and other health care providers to see plan members for less than their usual cost. If you belong to an HMO, you may need to see only doctors in the network in order for your plan to pay for it. HMO members are also often required to choose an in-network primary care physician (PCP) to coordinate member care and provide referrals to specialists.

2.      Point of Service (POS) Plans

POS plans are another type of managed health care. Unlike HMOs, POS plans sometimes allow you to see out-of-network doctors for a higher cost than in-network doctors. Also, you can usually see in-network specialists without a referral from their PCP. 

3.      Preferred Provider Organization (PPO) Plans

PPO plans are a third type of managed care. Unlike HMO and POS plans, PPO plans often don’t require you to choose a PCP. You also don’t usually need referrals to see other providers in the network. Seeing out-of-network doctors usually costs more, though. Some plans may also require you to pay the doctor directly and then file a claim with the PPO. 

4.      Private Fee-For-Service (PFFS) Plans

Unlike managed care plans, PFFS plans work without health care provider networks. On a PFFS plan you can see any Medicare-eligible doctor who accepts payment from that plan. Sometimes, you pay the doctor directly and then submit a claim to your insurance company. Your insurance company then pays you back. The amount that you are paid depends on your specific plan. Each plan sets its own terms. 

5.      Medical Savings Account (MSA) Plans

A Medicare MSA plan combines coverage for Medicare Part A and Part B through a High-Deductible Health Plan (HDHP) with a special savings account fund (the MSA). You can use your MSA to pay for health care expenses tax-free. Once you’ve paid the deductible, the plan covers expenses normally covered under Medicare. Unlike other Medicare Advantage plans, MSA plans don’t ever include Medicare Part D prescription drug coverage, so members need to find stand-alone Part D plans for help with Part D prescription drug costs. 

6.      Special Needs Plans (SNPs)

SNPs are Medicare Advantage plans that serve people with specific diseases or needs. They customize benefits, health care provider choices, and drug formularies (lists of covered drugs) to best meet the specific needs of the groups they serve. SNPs serve people living with disabilities, those suffering from certain chronic conditions and those living in institutions, among other groups. Some SNPs are for people who qualify for both Medicaid and Medicare.    

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. - 8 p.m. local time, seven days a week.    

Resources:

Medicare Advantage (Part C) – Medicare.gov

Your Guide to Medicare Private Fee-for-Service Plans – Medicare.gov

Your Guide to Medicare Medical Savings Account (MSA) Plans – Medicare.gov