Types of Medicare Advantage Plans

There are several different types of Medicare Advantage plans available for those who plan to enroll in private Medicare health insurance. Unlike Medicare Supplement (Medigap) coverage, Medicare Advantage plans are not standardized. Thus, each option can have a unique set of benefits for the enrollee.

Below, we review the different types of Medicare Advantage plans and how each type might benefit you.

The Different Types of Medicare Advantage Plans

Different types of Medicare Advantage plans include:

• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Special Needs Plans (SNP)
• Private Fee-for-Service (PFFS)
• Medicare Savings Account (MSA)

Each Medicare Advantage plan type is unique and provides enrollees with a different set of rules, networks, coverage, and more.

Medicare Advantage plans are private insurance policies that help with the gaps in Medicare coverage. Although they sound similar to Medigap plans, don’t confuse the two, as they have some notable differences.

To be eligible for Medicare Advantage enrollment, you must first sign up for Original Medicare (Medicare Part A and Part B). Then, review all available Medicare Advantage plans in your area. Understanding your out-of-pocket costs is essential when you enroll in a Medicare Advantage plan.

About 30% of Medicare recipients choose Medicare Advantage over Medigap due to the much lower monthly premium costs. The only premium cost you must pay for Medicare Advantage is your monthly Medicare Part B premium. However, copayments and deductibles can be much higher than for a Medigap plan.

When choosing a Medicare Advantage plan, you’ll need to consider the different plan types to ensure proper coverage. We’ve broken down each plan type to help you better understand coverage options.

What are the Types of Medicare Advantage Plans?

The four main types of Medicare Advantage plans include HMO, PPO, PFFS, and SNP plans. Another less common Medicare Advantage plan type is a Medicare Advantage Medical Savings Account.

Medicare Advantage Health Maintenance Organization (HMO)

Health Maintenance Organizations are a type of Medicare Advantage plan that requires you to choose a primary care doctor who facilitates your care, abide by a network of doctors and hospitals, and obtain referrals when seeing a specialist. When you have a Medicare HMO plan, you must receive services from doctors within your plan’s network to receive coverage for care.

Some HMO plans allow you to receive care from an out-of-network doctor. However, the cost will be higher, or in some cases, you will cover 100% of the bill. If your plan allows you to receive benefits outside of your network, that means there is an HMO-POS option available through your plan. You’ll want to review all your plan benefits prior to enrolling in coverage.

Should your doctor or healthcare doctor leave your plan’s network, your plan notifies you. Following notification, you’ll be able to choose another doctor within the program.

Medicare Advantage Preferred Provider Organization (PPO)

A popular type of Medicare Advantage plan is the Preferred Provider Organization. With a Medicare Advantage PPO plan, you’ll pay less when visiting doctors, hospitals, or any healthcare provider when they belong to your plan’s network. However, you’ll also receive benefits outside of your network at a higher out-of-pocket rate.

Each PPO plan allows you the freedom to go to hospitals and see specialists or doctors that are not included on your plan’s list. Be mindful, though, as these services come with additional costs.

PPO plans give you the freedom to see any doctor and do not require you to choose a primary care doctor. Plus, when you wish to visit a specialist, referrals are not often required.

Medicare Advantage Private-Fee-For-Service (PFFS)

Medicare Advantage Private Fee-for-Service (PFFS) plans are not as common as HMO or PPO plans, yet they are still a popular option for some Medicare enrollees. Medicare Advantage PFFS plans are different from other types of Medicare Advantage plans. Beneficiaries can seek healthcare from any Medicare doctor or hospital that agrees to the plan’s payment terms and grants treatment of services.

Nevertheless, not all doctors will accept the payment terms.

Of course, with the convenience of this plan type, your costs can be higher. But you have options for out-of-network healthcare doctors and hospitals if they agree with the plan’s terms.

These plans do not require you to select a primary care doctor. Yet, they may have arrangements with a specific network of doctors to keep your costs low.

In contrast, out-of-network doctors and hospitals can choose not to treat you in non-emergency situations. For emergencies, hospitals and other healthcare doctors may not refuse your treatment.

Medicare Advantage Special Needs Plans (SNP)

Medicare Advantage Special Needs Plans restrict enrollment to individuals with specific diseases or disabilities, economic status, or institutional status. These plans adjust doctor choices, benefits, and drug formularies to best meet the medical needs of the group they serve.

SNP coverage includes specialists to care for their members’ qualifying conditions. For the best care and lowest cost, you should get your services and care from doctors and hospitals in your SNP network.

SNP requirements:

• The plan must include Medicare Part D prescription drug benefits
• Members must have a primary care doctor or a care coordinator to assist with healthcare needs
• Members will need a referral from their doctor before seeing a specialist
• Yearly mammogram screenings, in-network Pap tests, and pelvic exams have coverage at least every other year

Seniors with specific disabling conditions, Medicaid, or those who are institutionalized may join a Special Needs Plan at any time once they qualify. You may enroll in an SNP in your service area during a Special Enrollment Period.

Your plan will set up the services and providers you need to keep you healthy. You should follow your healthcare provider’s instructions to ensure optimal results in the treatment of your condition.

Medicare Advantage Medical Savings Account (MSA)

Medicare Advantage Medical Savings Accounts are an uncommon type of Medicare Advantage plan that allows you to have a high-deductible plan with a dedicated health savings account.

This type of Medicare Advantage plan is not widely available and has low enrollment year over year.

Do All Types of Medicare Advantage Plans Cover Prescription Drug Benefits?

Medicare prescription drug coverage is just as important as your healthcare benefits. Without proper drug coverage, you could be responsible for a penalty in the future, or subject to high costs when picking up your medications from the pharmacy. Medicare Advantage plans that include drug coverage are known as Medicare Advantage Prescription Drug Plans (MAPDP).

Not all Medicare Advantage plans offer prescription drug coverage alongside their health benefits. Most HMO, HMO-POS, and PPO plans offer prescription drug coverage but are not required to. Thus, a handful of these types of Medicare Advantage plans do not offer prescription drug coverage. However, Medicare Advantage SNP plans are required to provide drug coverage.

On the other hand, less common plan types like PFFS and MSA plans do not always provide prescription drug coverage. So, if you enroll in a Medicare Advantage plan that does not include prescription drug coverage, you may be eligible to enroll in a Medicare Part D plan to cover these benefits.

How to Get Help Understanding All Medicare Advantage Plan Types

Understanding the different types of Medicare Advantage plans and all the supplemental coverage options that come with them can seem overwhelming. MedicareFAQ is here to help you!

If you need assistance understanding your plan options, we can work with you to determine the best policy for your healthcare needs. Call us today so we can help you review the types of Medicare Advantage plans that could be right for your health and budget.

If you can’t call now, complete our online rate form and discover the policy with the most value to you.

Enter ZIP Code

Enter your ZIP code to pull plan options available in your area.

Compare Plans

Select which Medicare plans you would like to compare in your area.

Get Quote

Compare rates side by side with plans & carriers available in your area.