If you’ve overheard your friends talking about their Medicare Advantage plan, and would like to know more, you’re not alone. Medicare Advantage also called “Part C”, is a popular choice because it provides seniors with coverage beyond Original Medicare.
Medicare Advantage plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans. Cost, coverage and rules for how you receive services vary from plan to plan, and comparing each type is a smart way to secure coverage that fits your needs.
Different Types of Medicare Advantage Plans
Health Maintenance Organizations (HMOs)
An HMO plan typically requires that you select a primary care doctor from the plan’s network of providers. In most cases, you’re required to use doctors, health care providers and hospitals within the plan’s network, except in an emergency. You may need a referral to see a specialist. Compared to other plans, an HMO can be a cost-effective option, but you may pay the full cost of care if you do not follow the plan’s rules. Prescription drug coverage is usually covered but individual plans vary.
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Preferred Provider Organizations (PPOs)
PPOs tend to be less restrictive than HMOs, but increased flexibility can cost you more. You do have the option to use any doctor, specialist, or hospital you choose, but you will pay less if you stay within the plan’s network. A referral is generally not required to see a specialist. Prescription drug coverage is often covered, but individual plans vary.
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Private Fee for Service Plans (PFFSs)
With a PFFS plan, the plan decides how much it will pay doctors and hospitals, and how much you will pay. If the plan has a network of providers, you don’t need to go to doctors or hospitals on the list. However, not all Medicare providers accept the PFFS plan—an important fact to know. Typically, with a PFFS plan, you do not need to get a referral to see a specialist. Prescription drug coverage may be covered, but individual plans vary.
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Special Needs Plans (SNPs)
Membership in an SNP is limited to people with specific diseases or who have specialized health needs. If you have a severe chronic condition, live in a nursing home, or receive both Medicare and Medicaid, you may be eligible. Benefits are tailored to meet the needs of the groups they serve and care is often limited to doctors and hospitals in the plan’s network. You may need a referral to see a specialist. All SNPs must provide Medicare prescription drug coverage.
Making Sense of Different Plans
Understanding the differences between the various types of Medicare Advantage plans will help you make an informed decision. Factors like cost, referrals and whether or not you can use doctors outside a plan’s network vary greatly—but can significantly impact your ability to receive affordable, timely care.
When comparing plans, be sure to think about the type of health care you need and how often you visit your doctor. While cost is a big consideration, it should not be the deciding factor.