Medicare Advantage Plans

What Are The Medicare Advantage Plans You Can Enroll In


Medicare Advantage Health Management Organization (HMO) Plans ask that you receive care from health providers in the plan’s network, except for emergency care, out-of-area urgent care, and out-of-area dialysis. Plans with a point-of-service option may allow you to go out-of-network for some services, but you will pay more if your provider is not in-network. You need to choose a primary care provider for HMO plans, and you will need a referral to see a specialist. 


Medicare Advantage Preferred Provider Organization (PPO) Plans have networks of doctors, healthcare providers, and hospitals. If you go to a provider that does not belong to the network, you will pay more. You do not need a primary care provider with a PPO Plan and do not usually need a referral to see a specialist. Costs will be lower for in-network specialists than for out-of-network specialists, as with all other providers under PPO Plans.


Private Fee-for-Service Plans operate differently than HMOs and PPOs. PFFS Plans contract with a network of providers that agree to always treat plan members. You can see any of the providers in the network or visit an out-of-network doctor, hospital, or provider that accepts the plan’s terms. The provider can decide whether to accept your plan’s terms and conditions of payment at each visit, but providers must treat you in an emergency. You do not need a primary care provider with a PFFS Plan, and you do not need referrals to see a specialist. Costs are lower if you stay in-network.


Medicare Advantage Special Needs Plans (SNP) are available for those with specific diseases or characteristics. This includes people who live in institutions or have home nursing care, people who are dual-eligible for Medicare and Medicaid, or people who have specific chronic or disabling conditions such as diabetes, End-Stage Renal Disease, HIV/AIDS, chronic heart failure, or dementia. These plans limit their membership based on the above qualifications and tailor their benefits, provider choices, and drug formularies to meet the needs of the group of people they serve. You must get your care from healthcare providers in the network unless it is an emergency or for out-of-area dialysis of End-Stage Renal Disease patients. SNPs have specialists in the diseases or conditions affecting their members. You may have to have a primary care doctor or a care coordinator, and you will have to get a referral to see a specialist.


Medicare Medical Savings Account (MSA) Plans are similar to Health Savings Account Plans. They combine a high-deductible health insurance plan with a medical savings account to pay healthcare costs. The Medical Savings Account deposits money into your account to pay for health care costs until you reach the deductible, at which point the high-deductible health plan will cover your costs.

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