Categories: Health

Understanding Plan Types

What Plans Can I Get Under Medicare Advantage?

Medicare Advantage Plans come in a number of types. Each type provides different networks, terms and conditions. These aspects may greatly impact the services you can receive.

Preferred Provider Organization (PPO) plans:

These plans incentivize doctors, health care providers and hospitals within the network. Your costs will be lower if you choose such providers.

Health Maintenance Organization (HMO) plans:

These plans allow you to visit certain doctors, health care providers, and hospitals, as long as they’re within a given network. Many primary physicians may have to provide referrals if you need to see specialized doctors. Medical emergencies are exceptions.

Special Needs Plans (SNPs):

These plans work best for certain populations that require certain types of specialized health care. Such populations include nursing home residents, people with chronic conditions, and people using both Medicare and Medicaid.

Medical Savings Account (MSA) plans:

These plans require a high-deductible and a bank account. Medicare then deposits funds into your account (typically below deductible). This money is accessible for health care services throughout the year. However, Medicare drug coverage is not provided. To receive drug coverage, you must join a Medicare Prescription Drug Plan.

Private Fee-for-Service (PFFS) plans:

These plans mirror Original Medicare. Typically, PFFS plans allow you to visit any provider or medical facility, if the plan’s payment terms are accepted. These plans differentiate payments based on the various types of doctors and providers. Required payments are made explicit.

HMO Point-of-Service (HMOPOS) plans:

These plans are modified HMO plans. Such plans permit you to receive certain out-of-network services, given a higher copayment or coinsurance.

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