Medicare Advantage (Part C) coordinated care plans, including Health Maintenance Organizations (HMOs), Point of Service plans (POSs) and Preferred Provider plans (PPOs) offer one-stop shopping for all of your health care. They combine hospital care and doctor’s visits and other outpatient care in a single plan. Many plans offer prescription drug coverage, too.
These plans are run by private companies. They’re called coordinated care plans because they are built on the idea of a network of doctors and hospitals working together to provide care. Each plan creates its own network.
How are these Medicare Advantage plans different from Original Medicare (Part A and Part B)?
These plans usually take a broader view of your care than Original Medicare does. Coordinated care plans cover all of the care covered by Original Medicare (except for hospice care, for which you can still receive coverage under Medicare Part A), but they also often include additional care designed to help you stay healthy. Some plans offer nurse helplines and other resources that can help you take a more active role in your health care.
Plan networks also work to improve the quality of care through management techniques for the providers in the network.
Unlike Original Medicare, these plans may have some limits on your choice of doctors and hospitals. The limits depend on the type of plan.
Health Maintenance Organizations (HMOs)
In an HMO-type plan, you must use doctors who belong to the plan, and go to hospitals in the network, for your care. If you go outside the
network for care—other than emergency care, urgent care or out-of-area renal dialysis—you must pay for your own care. These plans may require you to choose a primary care physician. This doctor may then manage any care you receive from specialists. In some plans, you may need a referral from this physician to see a specialist.
Point of Service plans (POSs)
A POS plan is a type of HMO plan that allows members the ability to visit doctors and hospitals outside their
network for some covered services, usually for a higher
copayment or
coinsurance. Some POS plans do not require referrals for specialty services.
Preferred Provider plans (PPOs)
In a PPO-type plan, you are likely to have more freedom to choose your doctor. These plans typically don’t require you to have a referral to see a specialist. And you can see doctors outside the
network without having to pay the entire cost yourself. If you do visit a doctor or hospital outside the network, though, you’ll usually pay a larger share of the cost of your care.
Important: Coordinated care plans offer a network of health care providers. You’ll usually pay more if you use providers outside the network; sometimes you’ll pay the entire cost.
