Medicare Advantage

There are 5 different types of Medicare Advantage plans—Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Medical Savings Account (MSA), Private-Fee-For-Service (PFFS), and Special Needs Plans (SNP). Here is an introduction to the different types of Medicare Advantage plans.

What is Medicare Advantage? How Does it Work?

Medicare Advantage provides the same coverage as Original Medicare, and depending on the plan, may also include other benefits such as dental, vision, hearing, and prescription drug coverage.

Advantage plans offer a wide network of healthcare providers which vary by location and the type of plan you choose. There is a wide variety of Advantage plans, and the cost will vary depending on the plan you select. The Medicare Detectives can shop hundreds of plans to find your ideal situation.

However, do keep in mind that many Medicare Advantage plans have little or no premiums at all.

Health Maintenance Organization (HMO) Plans

HMO plans are often the least expensive when compared to other plans. With HMO plans, you are required to choose a primary care doctor, and get referrals for specialist care. The HMO will have a network of covered providers, and out of network services are not covered, except in emergency situations.

Preferred Provider Organization (PPO) Plans

Preferred Provider Organization (PPO) Plans provide more flexibility than HMOs. There typically are in-network providers you can use, but you can also get care from out-of-network providers and still receive coverage. With PPOs, you are also not required to choose a primary care physician or receive specialist referrals.

Medical Savings Account (MSA) Plans

Medical Savings Account (MSA) Plans are a high deductible plan and a savings account in one. You will have to meet a high deductible in order for your coverage to start, but you can use the money deposited into the savings account to pay on this deductible. These plans are only available in certain states.

Private Fee-For-Service (PFFS) Plans

Private Fee-For-Service (PFFS) Plans will choose how much they will pay for your medical services, as well as how much you will pay. With a PFFS plan, you can typically see any healthcare provider for your care, even if the PFFS plan has in-network provider options. These plans are only available in certain states.

Special Needs Plans (SNPs)

Special Needs Plans (SNP) are reserved for those with specific health needs and who meet other specific criteria. If you have both Medicare and Medicaid, you qualify for a Dual Eligible Special Needs Plan (D-SNP).If you have a serious life-threatening illness, you will qualify for a Chronic Condition Special Needs Plan (C-SNP). And, if you live in an institution, such as a nursing home, you can qualify for an Institutional Special Needs Plan (I-SNP).

Regardless of the plan, all SNPs are required to provide prescription drug coverage.

Find Out Which Advantage Plan is Right for You with Medicare Detectives

There are a lot of Medicare Advantage plans for you to choose from. Between the different types of plans and who carries the coverage you need, finding the right coverage takes a team like Medicare Detectives. For more information, give us a call or visit either of our offices in St. Charles, Missouri or Sarasota, Florida.