Medicare Advantage Plans

Advantage Plans are sold through private insurance companies who contract with Medicare and ensure that there’s a wide variety of plans available and beneficiaries have access to the healthcare they need. One of the ways they do this is by including different plan options. There are many different types of Part C policies, so we’ll go over the basics and discuss which one could be right for you.

Health Maintenance Organization (HMO) policies have a specific list of providers that beneficiaries are encouraged to seek care from. If you decide to go out-of-network for a certain service, you’ll most likely end up not receiving any coverage and paying out-of-pocket. If you’re enrolled in an HMO, it’s best to work from the list of providers that are within your network. The majority of HMO plans will ask that beneficiaries get a referral from their primary care provider in order to see a specialist.

Preferred Provider Organization (PPO) policies are a bit different than HMOs. PPOs also have in-network providers, but beneficiaries have the option to receive care outside the network if they choose. However, beneficiaries will most likely pay more if they seek care from someone not included within their coverage. PPO plans do not require beneficiaries to choose a primary care provider or get referrals for specialists.

A Special Needs Plan (SNP) is a type of policy intended for those with a certain diagnosis. In order to qualify for this type of policy, you must have one of the diagnoses that determine eligibility. One of the biggest benefits of this type of policy is that they’re incredibly specific. They’re each formulated for those with the specific diagnosis, so their coverage is targeted towards the services most commonly needed.

A Private-Fee-For-Service (PFFS) policy determines how much it will pay for your covered health services and how much you will also pay; these rates are typically determined by Medicare. This plan does not require you to choose a primary care provider or get a referral to see specialists.

Medicare Medical Savings Account (MSA) policies come with a bank account and a high deductible health plan that is used to help pay for your medical expenses. Once you pay the high deductible, your plan will provide coverage for all your costs for the rest of the calendar year. The plan will also deposit a certain amount of money into the bank account that can go towards your high deductible.