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Medicare Advantage Plan Types

You have six plan types to choose from.

There are six Medicare Advantage plan types. The main differences between them are provider access and cost sharing.

Coordinated Care Plans
Heath Maintenance Organization (HMO) plans
Point of Service (POS) plans
Preferred Provider Organization (PPO) plans
Special Needs Plans (SNP)
Other Plans
Private Fee-For-Service (PFFS) plans
Medical Savings Account (MSA) plans

Coordinated care plans

Coordinated care plans contract with a 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.” of providers A person or organization that provides medical services and products, such as a doctor, hospital, pharmacy, laboratory or outpatient clinic. . Each plan has its own network. In general, your out-of-pocket costs will be lower for services you receive from network providers. 

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.

  • Primary care doctor coordinates your care
  • May require you to get a referral to see specialists or other providers
  • You may have to pay for the entire cost of care received from out-of-network 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.

  • Usually covers care received from both network and out-of-network providers
  • May allow you to see a specialist without a referral
  • You may pay more for care received from out-of-network providers
  • Out-of-network coverage may be limited to specific services or to a dollar amount

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.

  • Covers care received from both network and out-of-network providers
  • Usually allows you to see a specialist without a referral
  • You may pay more for care received from out-of-network providers

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 specific categories.

  • Designed for:
    • People with severe chronic conditions
    • People who are dual eligible (qualify for both Medicare and 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.
    • People living in a long-term care facility or who require an institutional level of care
  • May be an HMO, POS or PPO
  • 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 each year
  • You may use the money—tax free—to help pay for qualified health care services
  • Unused funds remain in the account and accumulate year to year
  • You may receive care from any provider you choose
  • Does not include prescription drug coverage
  • Does not charge a premium

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. may or may not have contracted provider networks. Most are non-network plans.

  • May cover services you receive from any provider in the U.S. who accepts Medicare
  • May allow providers to balance bill In Medicare Part B, doctors who do not accept assignment may use this method to bill you for an additional payment. Balance billing is also known as “excess charges.” A doctor’s excess charges cannot be more than 15% of the Medicare-approved amount. In some states balance billing may be limited to less than 15% or may not be allowed at all.  
  • Premiums and deductibles vary
  • May offer prescription drug coverage
  • May cover additional services, like routine eye and hearing exams