Types of Medicare Advantage Plans | Medicare Made Clear

There are six Medicare Advantage plan types. The main differences between them are provider access and cost sharing. Plans offered where you live may or may not include all of these types.

Four Medicare Advantage plan types are coordinated care plans. Coordinated care plans contract with a network of providers. Each plan has its own network. In general, you pay less out-of-pocket for services from network providers. The most common type of coordinated care plan is a health maintenance organization, or HMO, plan.

Two other 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 costs.

Types of Medicare Advantage Plans

Coordinated Care Plans Other Plans
Heath Maintenance Organization plans Private Fee-For-Service plans
Point of Service plans Medical Savings Account plans
Preferred Provider Organization plans  
Special Needs Plans  

Coordinated Care Plans

Health Maintenance Organization (HMO) Plan

  • Usually pay only for care you receive from providers in the plan network
  • Your care is coordinated by a primary care doctor
  • 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

Preferred Provider Organization (PPO) Plan

  • Covers care received from both network and out-of-network providers
  • Pays a portion for care that you receive outside the plan network
  • Usually allows you to see a specialist without a referral
  • You may pay more for care received from out-of-network providers 

Point of Service (POS) Plan

  • 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

Special Needs Plan (SNP)

  • Designed for:
    • People with severe chronic conditions
    • People who are dual eligible (qualify for both Medicare and Medicaid)
    • 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 Types of Medicare Advantage Plans

Medical Savings Account (MSA) Plan

  • Combines 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 (PFFS) Plan

  • May cover services you receive from any provider in the U.S. who accepts Medicare
  • May allow providers to charge you for an unpaid balance after you and the plan have paid your share (balance billing)
  • Premiums and deductibles vary by plan
  • May offer prescription drug coverage
  • May cover additional services, like routine eye and hearing exams

Types of Medicare Advantage Plans

Oct. 15 Remember this date!

Medicare lets you change plans during open enrollment each year, so you’re not locked in to one choice forever.

learn about changing plans >