Congress added Medicare Advantage plans to give you more coverage choices. That’s why you’ll find different kinds of plans in this category.
There are six Medicare Advantage plan types. The main differences between them are provider access and cost sharing. Coordinated care In Medicare Advantage (Part C), this refers to a kind of health care plan that links providers and services to deliver efficient, cost-effective patient care. Plan members usually have to use doctors and hospitals that are within the plan’s network. These plans are also referred to as “managed care plans.” plans have stricter rules and generally cost you less. Other plan types have more flexibility and may cost more.
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Coordinated Care Plans
Heath Maintenance Organization (HMO) plans
Point of Service (POS) plans
Preferred Provider Organization (PPO) plans
Special Needs Plans (SNP)
Private Fee-For-Service (PFFS) plans
Medical Savings Account (MSA) plans
Coordinated care plans
Four of the six Medicare Advantage plan types are coordinated care plans. These are also known as managed care plans.
Coordinated care plans contract with health care providers A person or organization that provides medical services and products, such as a doctor, hospital, pharmacy, laboratory or outpatient clinic. to provide cost-effective, quality care to plan members. These providers make up the plan’s network The group of health care providers, such as hospitals, doctors and pharmacies, that agrees to provide care to the members of a Medicare Advantage coordinated care plan or Medicare Part D prescription drug plan. These providers are called “network providers” and “network pharmacies.” . Each plan has its own network. In general, you will pay less out-of-pocket for services from providers in your Medicare Advantage plan’s network.
Plan pays a bigger share for services inside network.
You pay all or a larger part of the cost of services outside network.
Health Maintenance Organization plan
Health Maintenance Organization (HMO) A type of Medicare Advantage plan in which you must use doctors and hospitals in the plan’s network for your care. If you go outside the network for services other than emergency care, urgent care or out-of-area renal dialysis, you are responsible for paying for your own care. plans usually pay only for care you receive from providers in the plan network. You choose a primary care doctor within the network who coordinates your care. If you go outside the plan network for care, then you may have to pay the entire cost out-of-pocket. Also, plans may require that you get a referral from your primary care doctor to see specialists or other providers.
Point of Service plan
Point of Service (POS) A type of Medicare Advantage 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. is a benefit option offered with some HMO plans. It allows you to see either in-network or out-of-network providers for care. Generally, you will pay more for out-of-network care than you would if you received the same service from an in-network provider. The plan may limit out-of-network coverage to specific services or to a dollar amount. Many plans allow you to see a specialist without a referral.
Preferred Provider Organization plan
Preferred Provider Organization (PPO) A type of Medicare Advantage plan in which you can use doctors and hospitals in the plan’s network or go to doctors and hospitals outside the network. If you go outside the network, you’ll usually pay a larger share of the cost of your care. plans will pay a portion for care that you receive outside the plan network. But they usually pay more if you get care within the network. Many plans allow you to see a specialist without a referral.
Special Needs Plan
Special Needs Plans (SNP)
A type of Medicare Advantage plan that serves people with special health care needs.
are for individuals in three categories: 1) People with severe chronic conditions, 2) people who are entitled to both Medicare and a state Medicaid A medical assistance program for certain individuals and families with limited incomes and resources. Medicaid is jointly funded by the federal and state governments and managed by the states. It includes programs that help pay Medicare premiums and cost-sharing.
program and 3) people who live in a long-term care facility or who require an institutional level of care. An SNP plan can be an HMO, POS or PPO. All SNP plans must include prescription drug coverage.
Other Medicare Advantage plans
Two Medicare Advantage plan types offer nearly complete freedom of choice in health care providers. On the flip side, you take on more responsibility for your health care expenses.
Medical Savings Account plan
Medical Savings Account (MSA) A type of Medicare Advantage plan that combines a high-deductible health plan with a savings account. You use money from the savings account to pay your health care costs. plans combine a high-deductible health plan with a bank savings account. Money from Medicare is deposited into the account at the beginning of each year. You can use the money—tax free—to help pay for qualified health care services from any provider.
The plan covers your health care costs after you meet an annual deductible. The maximum annual deductible is set by law and is updated every year. If your savings account runs out before the annual deductible is met, then you must pay the difference out-of-pocket. Alternatively, any unused funds remain in the account and accumulate year to year.
MSAs do not charge premiums and do not include prescription drug coverage. You must buy a standalone Medicare Part D prescription drug plan if you want coverage for prescription drugs.
Private Fee-For-Service plan
Private Fee-For-Service (PFFS) A type of Medicare Advantage plan that allows you to visit any Medicare-eligible doctor, hospital or other health care service provider who is willing to accept the plan’s payment terms and conditions. plans may or may not have contracted provider networks, prior authorizations, and referral requirements, depending on whether they are network or non-network plans. Most PFFS plans are non-network plans that will cover services you receive from any provider in the U.S. who accepts Medicare and the plan's terms, conditions and payment rates.
Premiums and deductibles vary among PFFS plans. Also, some offer prescription drug coverage and some don’t. Many PFFS plans cover additional services, like routine eye and hearing exams.