What Are the Different Medicare Advantage Plans?
Medicare Advantage Plans, also called Medicare Part C, are private insurance plans that are an alternative to Original Medicare (Medicare Part A and Part B) offered by the U.S. government. These plans bundle your Original Medicare coverage together and usually include additional benefits, such as prescription drug coverage.
Below, we’ll guide you through the different types of Medicare Advantage Plans, as well as how to find the best plan type for you.
|How Medicare Advantage Plan Types Work||Jump to|
|Medicare Advantage HMO Plans||Jump to|
|Medicare Advantage PPO Plans||Jump to|
|Medicare Advantage PFFS Plans||Jump to|
|Special Needs Plans (SNPs)||Jump to|
|Medical Savings Account (MSA) Plans||Jump to|
How Medicare Advantage Plan Types Work
As stated above, Medicare Advantage enrollees will need to use health care providers within their plan’s network or service area. This is a key difference from Original Medicare and Medigap, which allow Medicare enrollees to see any doctor or specialist who accepts Medicare.
Some Medicare Advantage Plans offer non-emergency coverage outside your plan’s network, but that typically comes with a higher cost. However, the easiest way to keep your cost low is to get referrals from in-network specialists and see your plan’s preferred providers. 1
Medicare Advantage HMO Plans
In a Health Maintenance Organization (HMO) Medicare Advantage Plan, you generally must get your care from medical providers within your plan’s network. If you get care outside your plan’s network, you may have to pay for the total cost of the health care visit or service. The only exceptions are during: 2
- Emergency care
- Out-of-area urgent care
- Out-of-area dialysis
In most cases, you’ll need to choose a primary care doctor within your plan’s network and obtain a referral to see a specialist. Certain services, such as screenings for mammograms, don’t require a referral. HMO plans also cover prescription drug coverage if you enroll in a Medicare Advantage Plan offering drug coverage.
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Medicare Advantage PPO Plans
In a Preferred Provider Organization (PPO) Medicare Advantage Plan, you will find plans that offer a little more flexibility than most HMOs. PPOs have their own network of preferred doctors, specialists and hospitals, but you can see out-of-network health care providers. Usually, seeing out-of-network providers comes with a higher cost to you, so you’ll save money by staying in-network.3
Medicare Advantage PFFS Plans
A Private Fee-for-Service (PFFS) Medicare Advantage Plan determines how much it will pay doctors, specialists and hospitals for covered services and how much you will pay to get care. PFFS are unique in that you can get your health care from in-network providers or out-of-network providers if the health care provider accepts the plan’s payment terms. However, you will most likely pay more for non-emergency or non-urgent care services. Remember, not all health care providers will accept PFFS plans.4
Some PFFS plans include prescription drug coverage. If you need prescription drug coverage and your plan doesn’t offer it, you can enroll in a separate Prescription Drug Plan (Medicare Part D).
Special Needs Plans (SNPs)
Medicare Advantage Special Needs Plans (SNPs) are limited to people with diseases or specific medical characteristics. These plans all include prescription drug coverage, tailor their benefits, and include coordinators to best help the groups they serve. 5
There are three types of SNPs:
- Chronic Condition SNP (C-SNP) – for people with one or more qualifying chronic medical conditions.
- Institutional SNP (I-SNP) – for people who live in nursing homes or need nursing care
- Dual-Eligible SNP (D-SNP) – for people who are eligible for both Medicare and Medicaid
Each plan limits its membership, and members can only stay enrolled for as long as they continue to meet the eligibility criteria.
Medicare Advantage Medical Savings Account (MSA)
Medical Savings Account Medicare Advantage Plans combine a high-deductible insurance plan with a medical savings account that helps pay for your health care costs. Medicare gives your health insurance plan money each year for your health care, and then the plan deposits the money on your behalf. You can’t deposit your own money.
You can use the money in your account to pay for your health care costs, including costs not covered by Medicare. Any money from your account used to pay for Medicare Part A and Part B covered services will go towards your plan’s deductible.
Any leftover money will roll over and can be used in the future.
MSAs don’t have networks, which means you can see any doctor that accepts Medicare. You will need to enroll in a separate Prescription Drug Plan if you need drug coverage.1
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1 “Types of Medicare Advantage Plans,” Pages 15-24 of “Understanding Medicare Advantage Plans,” Centers for Medicare and Medicaid Services, Accessed Feb. 7, 2022.
2 “Health Maintenance Organization (HMO),” Medicare.gov, Accessed Feb. 7, 2022.
3 “Preferred Provider Organization (PPO),” Medicare.gov, Accessed Feb. 7, 2022.
4 “Private Fee-for-Service (PFFS) Plans,” Medicare.gov, Accessed Feb. 7, 2022.
5 “How Medicare Special Needs Plans (SNPs) Work,” Medicare.gov, Accessed Feb. 7, 2022.
Denise Austin, 65, Ensurem Ambassador
Best-Selling Author, Creator of Fit Over 50 Magazine
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