The type of Medicare Advantage Plan you choose will depend on your health needs, budget, and how much flexibility you want in making medical decisions without a referral from your doctor or other healthcare professional.

Before choosing a plan, it is important to understand all the specifics so that you can find one that offers what you need at an affordable price.

The Four Main Types of Medicare Advantage Plans are Medicare Advantage HMO, Medicare Advantage PPO, Medicare Advantage PFFS, and Medicare Advantage SNP.

Medicare Advantage HMO

Medicare HMOs are one of the most reliable ways to get access to your Medicare benefits. It’s often called “Medicare-managed care plans” as your care will be managed by a network of doctors and hospitals specific to the plan.
You can get care from any provider in the network, with one exception: emergency situations must be treated by someone within this preferred group who has been specially designated for such cases.

If your Primary Care Physician (PCP) cannot provide treatment for an issue, he or she will refer you to out-of-network specialists.
Medicare Part D drug plans are already included in many HMOs. Always check the plan’s formulary though to make sure your medications are covered.

Co-pays vary depending on what service is being used and can be as low as $0 per month or more than $100 for a single visit with an actual charge that varies from provider to provider.

Medicare Advantage PPO

Medicare Advantage PPOs (Preferred Provider Organization) are preferred by many people as they can get the same benefits as an insurance company, but at lower prices.

Most PPO plans provide access to doctors and hospitals, but there are some limitations. In most cases, you may see any provider that accepts Medicare; however, out-of-network costs will be higher than traditional programs as they’re not covered by your insurance plan or Part D drug benefits.

However, since Part D drug plans are often built into the plan, you will not have any additional costs for it.

Medicare Advantage PFFS

Medicare Advantage PFFS stands for Private-Fee-for Service. These plans are great for those that want to be in control of their healthcare spending.

PFFS plans offer a lot of options and flexibility. Some have preferred providers that give discounts, while others let you choose any doctor or hospital in your area at full. The cost will depend on what kind of insurance policy is included with the plan – there’s no one “perfect” option.

Medicare Advantage PFFS plans usually cover prescription drugs. You don’t have to select a PCP or get referrals before seeing specialists, and the list of covered services is extensive.

Medicare Advantage SNP

A Medicare Advantage Special Needs Plan (SNP) suits best for people with specific disabilities, such as dementia, diabetes, and autoimmune disease. You must seek care from in-network providers unless there is an emergency when you need urgent care but you’re outside of the area of coverage, or if you have end-stage renal disease and you need dialysis outside of your area of coverage.

SNP plans require you to select a preferred provider and then get referred for specialty care. In addition, most SNP plans offer coverage of prescription drugs.

We know that navigating the Medicare system can be confusing, and we’re here to help. Our advisors at The Medicare Research Institute are happy to answer all of your questions about Medicare Advantage plans so you will have a clear understanding of what they offer, how much it costs, whether or not it covers any specific supplemental benefits in addition to traditional Medicare coverage, and more.

If you want some personalized guidance in making this important decision for yourself or someone close to you who’s nearing age 65, contact us today!