There are only a few primary types of Medicare Advantage Plans and most of the different Medicare Advantage Plans may also include prescription drug coverage:
- Health Maintenance Organization (HMO) – A Health Maintenance Organization that is contracted with Medicare provides you with access to a network of doctors and hospitals that coordinate your care, with an emphasis on prevention. This allows you to get more benefits than the Original Medicare Plan and many Medicare Supplement plans. An HMO has the tightest or most restrictive network where your care may not be covered if you go outside the HMO network without obtaining prior approval.
- Health Maintenance Organization with a Point of Service Option (HMO POS) – This is a Health Maintenance Organization that provides a more flexible network allowing you to seek care outside of the traditional HMO network under certain situations or for certain treatment. You may pay some additional fees for using the POS (out-of-network) option.
- Preferred Provider Organization (PPO) – A Preferred Provider Organization provides access to a network of doctors and hospitals that coordinate your care. As with an HMO, a PPO allows you to get more benefits than the Original Medicare Plan and many Medicare supplement plans. PPOs have a network of doctors and facilities, but also allow you to use any doctor or hospital outside of the network for a higher copay or coinsurance.
- Private Fee-For-Service (PFFS) – A Private Fee-For-Service Plan is a type of Medicare Advantage Plan in which you may go to any Medicare-approved doctor or hospital that accepts both Medicare and the plan’s payment (or terms and conditions). The insurance plan, rather than the Medicare Program, decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare-covered benefits. You may have extra benefits the Original Medicare Plan doesn’t cover. The PFFS Plans are the most flexible, but a doctor or hospital can make patient-by-patient or visit-by-visit decisions of whether to accept the PFFS Plan Member.
- Medicare Special Needs Plans (SNPs) – A Special Needs Plan is a Medicare Advantage Plan with coverage designed especially for Medicare beneficiaries with certain chronic conditions (like Diabetes) or have some other specific need. Usually only people with certain conditions or needs are allowed into a SNP.
- Medicare Medical Savings Account (MSAs) – A Medical Savings Account is a combination of a high-deductible health plan and a bank account where your Plan deposits a certain amount of money per year. You use the money in your account to pay for Medicare Part A and Medicare Part B expenses, and when your Plan deductible is met, the Plan pays for any further Medicare-covered services. MSAs are only MAs and not MA-PDs. That is, MSAs do not offer Medicare Part D prescription drug coverage.