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The Different Types of Medicare Advantage Plans


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7/1/2016
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Medicare is a government-funded insurance program that allows people over 65 to have a proper amount of health care a regular insurance company may not be able to provide. A Medicare Advantage Plan is a plan offered by insurance companies contracted by the government to provide Medicare-like services but with more coverage and different prices. There are several types of Medicare Advantage Plans; here is a list of Medicare Advantage Plans you may be able to choose from:

  • Health Maintenance Organization (HMO): In HMO plans you typically cannot receive care from any doctor or hospital. You must receive care from doctors and specialists on the HMO list, except for emergency situations. However, you can choose your primary doctor under an HMO plan. If you do not visit a doctor under the plan, you may have to pay in full for the care you received. You must have a referral to see a specialist, unless it is for certain services, such as yearly screenings. Some HMO plans will pay for your prescription drugs. If you want this service, look for an HMO plan that will provide this for you.
  • Preferred Provider Organization Plans (PPO): With PPO plans, you can visit any doctor you wish, even if they are not provided by the plan’s network. These visits may cost you more, but a portion of them will still be covered by your provider. Most PPO plans will cover the cost of prescription drugs; if you want this coverage; find the plan that will provide this service. You do not need to choose a primary care doctor and you do not need a referral to see a specialist. If you use specialists on the PPO plan, your deductible will be cheaper. PPO plans will generally offer more benefits than Original Medicare, but you will have to pay for these services.
  • Private Fee-for-Services Plans (PFFS): PFFS plans are Medicare Part C plans that determine how much you will pay doctors, health care providers, hospitals, and how much you must pay when you receive the care. PFFS plans are offered by private insurance companies. Just like a PPO plan, you can see any doctor under the PFFS plan’s network or any out-of-network doctor, but you may pay more for out-of-network doctors.
  • Special Needs Plans (SNP): SNPs are provided to individuals who have specific diseases. This plan will provide them with benefits shaped to fit their needs. Usually, members of SNPs must receive care from the doctors provided by the plan, unless it is an emergency or the patient has End-Stage Renal Disease. All SNPs are required to offer prescription drug coverage. With the SNP, you will need to choose a primary doctor and get a referral before you see a specialist. SNPs are limited to certain groups of people such as people who live in a nursing home, people who are eligible for Medicare and Medicaid, and people who have chronic or disabling diseases


Category: Disability Insurance - ERISA


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