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Medicare Advantage Plans

Medicare Advantage Plans

There are six types of Medicare Advantage plans. Each type has different features. It’s important that you understand how each plan type works so you can make the right choice for your lifestyle, health, and budget.

These six plans fall into two categories:

  • Coordinated plans, also called managed care plans,  require you to have a primary care physician who makes decisions about which care providers and facilities you may use.
  • Non-coordinated plans allow you to choose any care providers and facilities with the understanding that you may pay additional costs.

Let’s go through each of the six types of Medicare Advantage plans.

Health Maintenance Organization (HMO)

A Health Maintenance Organization (HMO) is a coordinated care plan that requires you to use care providers within their HMO network. The network makes care more affordable.

Point of Service (HMO-POS)

A HMO Point of Service (POS) is a coordinated care plan similar to an HMO. The plan allows you see care providers outside of the network for some services.

Generally, you pay a higher copay or coinsurance for the services outside of the POS network. Some plans do not require you to get a referral from your primary care physician.

Preferred Provider Organization (PPO)

A Preferred Provider Organizations (PPO) is a coordinated care plan that contracts with a network of care providers. You are allowed to use care providers outside of the PPO network. However, you may pay additional costs.

Special Needs Plans (SNP)

A Special Needs Plans (SNP) is a coordinated care plan for people with special medical needs that require the collaboration of many medical specialties. Each plan has additional eligibility requirements and offers different services. SNP’s are required to provide prescription drug coverage.

Private Fee for Service (PFFS)

A Private Fee for Service (PFFS) is a non-coordinated care plan that allows you to use any care provider that accepts the terms, fees and conditions of the Private Fee for Service plan. Providers may accept those terms on one visit but are not required to accept them on subsequent visits. If you live in a service area that has at least 2 network plans, the PFFS plan must include a contracted network of providers that are cannot turn you away and must accept your plan.

Some Private Fee for Service plans do not include prescription drugs. If you enroll in one of these MA-only plans, this is the only instance where you may purchase a standalone prescription drug plan (PDP).

Medical Savings Account (MSA)

A Medical Savings Account (MSA) is a non-coordinated care plan that combines Medicare Part A and Medicare Part B coverage with a medical savings fund.

Medicare deposits money into an account which you can use to pay your Medicare deductible or other IRS-approved medical expense.

Medical Savings Plans do not include prescription drugs, so you may purchase a standalone prescription drug plan (PDP).

What If I Don’t Like My Medicare Advantage Plan?

If you choose a Medicare Advantage plan, you are guaranteed to receive at least the same coverage as original Medicare.

If you are not satisfied with your Medicare Advantage plan, you have limited choices:

  • You can switch to a different Medicare Advantage plan during the Annual Enrollment Period (AEP). You can also go back to original Medicare and stand alone drug plan
  • You can change plans during the Medicare Advantage Open Enrollment Period (OEP).
  • You may qualify for a Special Enrollment Period (SEP) based upon your personal circumstances.
  • You may qualify to go back to original Medicare if you are in your Trial Right Period.

Now that you understand the types of Medicare Advantage plans, how can you choose the right plan for your lifestyle, your health, and your budget?