4- Types of Medicare Advantage Plans you should know

Medicare advantage plan is also known as Medicare Part C Plan. It is provided by private insurance companies that are approved by Medicare. Original Medicare plans do not cover all medical expenses. You may also consider Medicare Supplement Plans 2019.  You might need a more advanced plan to cater for extra services that the original Medicare doesn’t provide. Medicare advantage caters for extra services like dentures, optical, hearing checkups and even foot examinations.

Medicare Advantage plan comes in six different types. The main different is with the functionality and amount of premium that come with each type. Let’s find out.


Health Maintenance Organization plan (HMO)

If you have this type of Medicare Advantage plan, you will receive medical services from hospitals and doctors that are on Medicare network except for different cases. You are allowed to have referrals from your primary doctor. The only exception are on emergency cases, when you’re on out-of –area and need an urgent care or you’re out-of-area and you need emergency dialysis.

HMO covers Prescription drugs in most cases but you will have to talk to your care provider to be sure. In case your primary doctor leaves the plan you will be notified to choose another doctor within the plan. If you sought medical services anywhere else, you are likely to pay all medical costs on your own.

Preferred Provider Organization plan (PPO)

If you have this type of plan, you are allowed to receive medical services from hospitals and care givers outside Medicare Network. However, you will pay less if you use hospitals and care givers who are on Medicare Network. This means that if you use the services of the hospitals and doctors out of Medicare Network you will pay more premiums.

If you need prescription drug to be catered for you should join PPO that has Part D in it. You cannot join Medicare Prescription Drug part C if your PPO doesn’t have an in-build part C.

Private Fees for Service plan (PFFS)

This plan doesn’t provide the original Medicare. PFFS determines the cost they shall pay and how much you hall pay for the same services. It is sort of cost sharing. You can get medical services from any doctor and hospital on PFFS Network.

You will not need to choose a primary doctor neither are you required to have a referral letter to visit other medical services on PFFS plan. You are allowed to apply for Part C plan for your drug prescription.

Special Needs Plans (SNPs)

This type is for members with special needs. You must get medical services to doctors and hospitals in the SNPs medical Networks except for emergencies. You must choose your primary doctor in this type. SNPs covers prescription drugs cost.

Apart from the above four types there are additional two special types namely, HMO Point of Service (HMOPOS) which allows you to get services from other hospitals and care givers at extra costs. The other one is Medical Savings Account Plan (MSA). This type combines your medical high deductibles with your bank such that some money will be credited to your bank account to cater for deductibles.