In case you did not know, Medicare Advantage plans provide you an alternative means to procure your Original Medicare (Part B and Part A) advantages. You must be aware of the different types of Medicare Advantage plans, which this article will cover. Keep in mind that not all of these plan types may be available in the area you reside in.
PPO (Preferred Provider Organization)Â
A few of the employer group Medicare plans are Preferred Provider Organizations, so you may be aware of some details regarding this plan type. A PPO plan (Medicare Advantage) generally:
- It allows you to reach out to providers who are outside the provider network of the plan. However, these may charge you more money for visits.
- Has provider networks
- Does not require you to select a care provider (primary)
- Does not require a referral if you would like to consult with an experienced specialist
HMO (Health Maintenance Organization) Plan
You may be acquainted with this plan type if an employer ever covered you via an HMO. An HMO Medicare Advantage plan generally:
- Requires you to reach out to providers within the provider network of the plan to be completely covered
- Has provider networks
- Requires a referral if you would like to consult with an experienced specialist
- Requires you to select a care provider (primary)
Health Maintenance Organization plans have reduced premiums most of the time compared to other Medicare Advantage plan types.
PFFS (Private Fee for Service)
A PFFS plan establishes its own structure of payment and decides exactly how much it will pay its providers (Medicare), and how much money you will be paying in the capacity of a patient. You should know the following important things regarding a PFFS plan:
- A few of the plans allow you to reach out to any provider (health care) who accepts the payment terms of the PFFS plan as well as the Medicare assignment
- Does not require you to select a care provider (primary)
- Does not require a referral if you would like to consult with an experienced specialist
- You only have to pay the copayment or coinsurance amount of the plan at the time of service
HMO-POS (Health Maintenance Organization Point of Service)Â
This particular plan type is quite similar to a Health Maintenance Organization plan but might allow you to receive care outside the plan’s network. An HMO-POS plan generally has provider networks and lets you reach out to a provider outside the network of the said plan. However, like PPO, such a provider may charge you a higher coinsurance or copayment for such visits.
If you have any questions regarding the different types of Medicare Advantage plans available, please contact us!
