Medicare Advantage plans are offered by private companies as an alternative to "Original Medicare." While they all cover Part A and Part B, the way you access your care—and what you pay for it—depends on the plan type.
1. HMO: Health Maintenance Organization
HMOs are generally the most affordable plans but have the most rules.
- The Rule: You must use doctors and hospitals within the plan’s network (except for emergencies).
- The Requirement: You’ll need to choose a Primary Care Physician (PCP) and get a referral to see a specialist.
- Best for: Those looking for low premiums and who don't mind staying within a specific network.
2. PPO: Preferred Provider Organization
PPOs offer more freedom than HMOs but usually come with higher monthly premiums.
- The Rule: You can see any doctor you like, but you’ll save money by staying in-network.
- The Requirement: No referrals are needed to see a specialist.
- Best for: People who want flexibility and don't want to manage referrals.
3. HMO-POS: HMO Point-of-Service
This is a hybrid "step-up" from a standard HMO.
- The Rule: It functions like an HMO, but you have the option to go out-of-network for certain services (usually at a higher cost).
- The Requirement: You still typically need a PCP and referrals for in-network care.
- Best for: Those who want HMO prices but want a safety net for specific out-of-network needs.
4. PFFS: Private Fee-for-Service
These plans are unique because the plan—not Medicare—determines how much it will pay providers.
- The Rule: You can go to any Medicare-approved doctor who accepts the plan’s payment terms. Note: Not all doctors will accept these terms, so you must check before every visit.
- Best for: People in rural areas or those whose preferred doctors aren't in standard HMO/PPO networks.
5. SNP: Special Needs Plans
SNPs are membership-limited to people with specific "special needs."
- The Rule: These plans tailor their benefits, provider choices, and drug formularies to the group they serve (e.g., people with Diabetes, ESRD, or those who have both Medicare and Medicaid).
- The Requirement: You must meet the eligibility criteria to join.
- Best for: Individuals with chronic conditions who need specialized coordination of care.
6. MSA: Medical Savings Account
This is a high-deductible plan combined with a specialized bank account.
- The Rule: The plan deposits money into a savings account for you to use for healthcare costs. Once you spend that and hit your deductible, the plan covers your remaining costs.
- Best for: Those who are healthy and want to "self-insure" while having protection against major medical expenses.
7. PPO-POS: PPO Point-of-Service
Though less common, some PPOs offer an "extended" out-of-network benefit similar to a POS.
- The Rule: It provides even broader access to out-of-area providers than a standard local PPO.
- Best for: Frequent travelers or "snowbirds" who live in different states throughout the year.
Confused by the options? We can help. Medicare is not one-size-fits-all. Our licensed agents specialize in matching your specific health needs and budget with the right plan for you. Don't leave your coverage to chance—call us for a review at 1-855-952-1941 (TTY: 711) from 8 AM to 8 PM CST. Weekend appointments available upon request.