Medicare Advantage Plan Types

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.

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 to provide cost-effective, quality care to plan members. These providers make up the plan’s networkThe 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.”. The term “provider” refers to health professionals, pharmacies and medical facilities. 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.

Health Maintenance Organization plan

Health Maintenance Organization (HMO) 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.

Preferred Provider Organization plan

Preferred Provider Organization (PPO) 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.

Point of Service plan

Point of Service (POS) 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.

Special Needs Plan

Special Needs Plans (SNP) 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 either an HMO or a 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 risk and responsibility for your health care expenses.

Medical Savings Account plan

Medical Savings Account (MSA) 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 drug plan if you want coverage for prescription drugs.

Private Fee-For-Service plan

Private Fee-For-Service (PFFS) plans will cover services you receive from any provider in the U.S. who accepts the plan’s terms, conditions and payment rates. You need to make sure that the providers you choose will accept what your plan will pay. It’s wise to do this each and every time, before you receive care. If your provider charges more than your plan will pay, then you may owe the difference out-of-pocket. In some cases, you may have to pay the entire cost.

Premiums and deductibles vary among PFFS plans. Also, some offer prescription drug coverage and some don’t. Many PFFS plans cover additional services, like nurse help lines or gym memberships.

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