Medicare Advantage Plans provide you with Medicare Part A and Part B benefits, plus extra coverage, from a private insurance provider. When it comes to Medicare Advantage (MA) Plans, you can enroll in different types.
#1: Health Maintenance Organizations (HMOs)
One of the most common types of Plans is HMOs. With an HMO, you have to get your medical care from providers who are part of the HMO network. This allows the insurance company to control who you see and how much your visits cost them.
With an HMO, your relationship with your primary care doctor is important, as you have to get a referral from your primary care doctor to see a specialist. Once you see a specialist, you can get treatment options if needed.
With an HMO, you can only get care outside of your network in the event of an emergency where you need immediate medical care right where you are. Otherwise, you will have to pay for any medical care you get outside of your plan.
#2: Preferred Provider Organizations (PPOs)
The second most common type of Plan is PPOs, which operate a little differently than HMOs. With a PPO, they prefer you to work with providers who are within their network. However, you can choose to see a doctor outside of their network for non-emergency situations, and they will still pay for your care. Of course, you will have to pay a larger co-pay if you choose to work with someone outside their network.
If you see someone in-network, you will incur the lowest personal cost. You can also ask to see a specialist without getting a referral from your primary care physician.
#3: Private Fee for Service (PFFS)
A less common type of Plan is the Private Fee for Service plan. With PFFS, you are allowed to go to any provider that is approved to work with Medicare, given that they accept your particular PFFS payment terms. Not all doctors that accept Medicare will work with people on a PFFS Plan, so you have to do your due diligence checking things out before finding a doctor with this plan.
#4: Special Needs Plans (SNPs)
This is one of the least common types of Plans, as this type is only applicable to people in specific situations. For example, individuals who qualify for SNPs generally have to have specific chronic diseases. They may also live in an intuitional setting or a nursing home. SNPs also apply to people who qualify for both Medicaid and Medicare.
The most common types of Medicare Advantage Plans are HMOs and PPOs, with PFFS being less popular and SNPs only applying to a very small population. Before signing up for a Medicare Advantage Plan, be sure you fully understand how the plan works and what medical providers you will be allowed to work with.
To learn more, contact a Medicare Advantage Plan insurance provider.