Types of Medicare Advantage plans and their features

Types of Medicare Advantage plans and their features

Medicare Advantage plans are a type of health insurance and an alternative to Medicare. They are also referred to as Medicare Part C and are offered by private companies. They cover care provided in hospitals and medical care that could be required outside a hospital, such as vision care or dental care. Unlike Original Medicare, which offers only hospital and medical insurance, most Medicare Advantage plans can be very convenient and meet all your medical needs.

Listed below are some of the types of Medicare Advantage plans and their features.

Health Maintenance Organization (HMO)
One of the basic types among the Medicare Advantage plans, HMO, covers the services and care provided by doctors or healthcare professionals within a certain network. If you seek care outside this network, you must pay the bill yourself. However, if you need assistance during an emergency or require urgent care that is not available in the area, you can seek treatment elsewhere. Also, if dialysis is not available in the network covered by the HMO plan, you can seek treatment elsewhere. In most plans in this category, you would need to choose a primary care doctor and would need a referral to see a specialist. However, you would not need a referral for certain tests, such as an annual screening mammogram. Therefore, it might be a good idea to get approval if you need a certain service.

Preferred Provider Organization (PPO)
With this type of Medicare Advantage plan, you would pay less for using healthcare professionals within the network, such as hospitals or doctors. These are known as preferred specialists. However, you can use healthcare facilities and experts that are not a part of the network, but they would cost you more if the provider agrees to your choice of treatment option. Also, an annual deductible may or may not be imposed by the provider. Most plans cover prescription medications. However, checking with the provider should help clear any doubts and queries that you may have.

Private Fee-For-Service (PFFS)
This Medicare Advantage plan is rare and offered by private insurance companies. This plan too has a network of healthcare providers, but in some of these plans, you can seek treatment from any doctor or health care establishment that accepts the payment terms of this plan. You don’t need a referral to see a specialist, and most plans cover prescription medications. The Annual Notice of Change and Evidence of Coverage are yearly documents that you will receive that will inform you of the amount you will need to pay for services.

Special Needs Plan (SNP)
These plans are for individuals with chronic health conditions such as diabetes, as the medications and services covered are tailored to the patient’s specific needs. Individuals who live in institutions such as a nursing home or require nursing care also qualify for enrollment for this plan. In this plan, you would need to choose a primary care doctor or have a care coordinator to help you with your conditions. You might not need a referral to see a specialist in most cases.

Medical Saving Account (MSA)
For these plans, you need to have a savings account in which money that you need for your medical care will be deposited every month. They are high-deductible plans and are also quite uncommon. These plans do not cover the cost of prescription medications.

HMO Point-of-Service (HMO-POS)
In these plans, you can choose treatment options inside or outside a network if you can pay for them. Also, the deductibles for in-network and out-of-network charges are different.

Among the above-listed Medicare Advantage plans, the HMO and PPO plans are the most common. Also, it should be noted that you can switch from a Medicare Advantage plan to Original Medicare at any time during the first year without a penalty.