Types of Medicare Advantage Plans

An overview of the five main types of Medicare Advantage plans, which include HMO, PPO, PFFS, SNP, and MSA Medicare Advantage plans.
Types of Medicare Advantage Plans

Medicare Advantage programs come in a variety of forms. These plans are offered by commercial insurance providers that have received approval from Medicare, and they are permitted to include additional coverage beyond Part A and Part B. For instance, some plans provide prescription medication coverage. Plans may also include regular dental and eye treatment as well as other medical services that Original Medicare does not cover (Part A and Part B).#### There are 5 types of Medicare Advantage plans* Health Maintenance Organization(HMO)* Preferred Provider Organization (PPO)* Private Fee-For-Service (PFFS)* Special Needs Plan (SNP)* Medical Savings Account (MSA)## Health Maintenance Organization(HMO)The most popular type of (MA) plan is the Health Maintenance Organization (HMO). The plan's network of physicians, pharmacies, hospitals, and other healthcare providers must be used (in network). Despite having fewer options for doctors to choose from, your out-of-pocket expenses will often be cheaper than with other plans like PPOs. The majority of HMOs also need your primary care physician to recommend you to a specialist. In most circumstances, prescription medications are covered.To participate in a Medicare HMO, you must have both Parts A and B. In general, you will continue to pay your Medicare Part B payment, but certain HMOs may cover a portion of it. Some HMOs may impose an extra cost in addition to your Part B payment. If you desire Part D coverage, you will get it through your HMO. Plans may impose a higher premium if you also have medication coverage.Unless you require emergency medical care, you must see providers that are part of the HMO's network. A point-of-service (POS) option is available by some HMOs, allowing you to get some services outside of the network. You will still be protected in these circumstances, although typically at a greater rate.## Preferred Provider Organization (PPO)Patients pay less by using the approved network of the insurance plan's physicians, pharmacies, hospitals, and other healthcare providers. Services provided outside of the network typically cost extra. To see a specialist, you don't require a referral. Most insurance plans cover prescription medications. PPOs must offer you the same protections, rights, and benefits as Original Medicare, just like all Medicare Advantage Plans, but they are free to do so with their own set of limitations. Some PPOs also include extra benefits like care for your eyes and ears.## Private Fee-For-Service (PFFS)In general, Medicare Advantage PFFS plans let you visit any doctor as long as they accept the provisions of the plan and its payment structure. Some Medicare Advantage PFFS plans feature networks of contracted healthcare professionals who have agreed to treat any patient enrolled in the plan. For this kind of coverage, you won't need a primary care physician or referrals. You are only accountable for meeting the plan's cost-sharing criteria. If your PFFS plan doesn't offer Medicare drug coverage, you are allowed to join a separate Medicare drug plan to get Part D (drug coverage).## Special Needs Plan (SNP)Individuals with certain illnesses, specialized medical requirements, or those who also qualify for Medicaid coverage might get benefits and services through special needs plans. There are three different special needs plans, each of which caters to individuals with particular needs:#### Chronic-Condition Special Needs Plan (C-SNPs)* You suffer from one or more severe or disabling chronic illnesses like:* Chronic alcohol and other drug dependence* End-stage renal disease* AIDS* Cancer* Dementia* Certain neurologic disorders#### Institutional Special Needs Plan (I-SNP)For those who reside in a facility, such as an assisted living facility, nursing home, or long-term care skilled nursing facility.#### Dual-Eligible Special Needs Plan (D-SNP)For people who have Medicare and Medicaid (dually eligible individuals). D-SNP's contract with the Medicaid program in your state to assist in coordinating your Medicare and Medicaid coverage.In general, you will continue paying your Medicare Part B payment, however, specific SNPs will cover a portion of it. You must have both Parts A and B in order to join an SNP. In addition to your Part B cost, specific SNPs will require an extra fee. If you qualify for an SNP, you could also be eligible for other types of premium assistance. SNPs must provide Part D insurance as well.Your Medicare SNP might be a Preferred Provider Organization (PPO) or a Health Maintenance Organization (HMO) (PPO). Depending on your plan, you might need to see in-network doctors in order to get coverage or you might be able to travel outside the network.## Medical Savings Account (MSA)Plans combine medical savings account that you may use to pay for your medical expenses with a high-deductible insurance plan (HDHP). HDHPs have high deductibles that you must reach in order to be covered. In other words, if you have an HDHP, you will pay in full for the majority of medical services up until you meet your annual deductible. Once met, the HDHP pays for all of your expenses for the remainder of the year.* The bank account and the amount of the contribution are determined by your plan. The plan's contribution is often less than the entire deductible.* Contributions to an MSA are tax-free as long as they are utilized to cover eligible medical costs.* More money cannot be added to the account. You must pay out-of-pocket until you have reached your deductible after using all of the funds in the account.* Your MSA plan pays 100% of the price for Medicare-covered procedures once you've met your deductible.| | HMO | PPO | PFFS | SNP | MSA || --- | --- | --- | --- | --- | --- || **Premium**Do most insurance policies include a monthly premium? | **Yes**Many charges a premium in addition to the monthly Part B premium. | **Yes**Many charges a premium in addition to the monthly Part B premium. | **Yes**Many charges a premium in addition to the monthly Part B premium. | **Yes**Many charges a premium in addition to the monthly Part B premium. | **No**You won't have to pay a separate monthly premium, but you'll continue to pay the monthly Part B premium. || **Drugs**Does the plan offer Medicare prescription drug coverage (Part D)? | **Usually**If you join an HMO plan that doesn't offer drug coverage, you can't get a separate Medicare drug plan. Usually If you join a PPO plan that doesn't offer drug coverage, you can't get a separate Medicare D | **Usually**If you join a PPO plan that doesn't offer drug coverage, you can't get a separate Medicare drug plan. | **Usually**If you join a PFFS plan that doesn't offer drug coverage, you can get a separate Medicare drug plan. | **Yes**All SNPs must provide Medicare prescription drug coverage (Part D). | **No**You may join a separate Medicare drug plan. If you already have a Medigap policy with drug coverage, you can continue to use this coverage. || **Providers**Can I use any doctor or hospital that accepts Medicare for covered services? | **Sometimes**You generally must get your care and services from doctors, other health care providers, or hospitals in the plan's network (except emergency or urgent care or out-of-area dialysis). In an HMOPOS plan you may be able to get some services out of network for a higher copayment or coinsurance. | **Yes**Each plan has a network of doctors, hospitals, and other providers that you may go to. You may also go out of the plan's provider network, but your costs may be higher. | **Yes**You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan's payment terms and agrees to treat you. If the plan has a network, you can use any of the network providers (if you go to an out-ofnetwork provider that accepts the plan's terms, you may pay more). | **Sometimes**If your SNP is an HMO, you must get your care and services from doctors or hospitals in the SNP's network (except emergency or urgent care or outof-area dialysis). However, if your SNP is a PPO you can get Medicare covered services out of network. | **Yes**MSA plans generally don't have network providers. You may go to any Medicareapproved provider for services Original Medicare covers. || **Referral**Do I need a referral from my doctor to see a specialist? | **Yes** | **No** | **No** | **Maybe**If the SNP is an HMO, you need a referral. If the SNP is a PPO, you don't need a referral. | **No** |---## What is the cost of Medicare Advantage?You are required to pay the monthly Medicare Part B fee regardless of the Medicare Advantage plan you select. The average person's Part B premium in 2022 is estimated to be $158.50 per month. Customers' Part B premiums are paid by some MA plans (in full or in part).You are responsible for paying the Medicare Advantage plan's own premium in addition to your Part B cost. The typical Medicare Advantage premium in 2022 will be roughly $19 per month, according to CMS. However, your yearly deductible and copayments/coinsurance may be greater with certain plans that have no cost at all.**Continue reading:** [What is the cost of Medicare Advantage?]()