Medicare Advantage Plans (Part C plans) are offered by private Medicare-approved companies. These plans provide you with Original Medicare coverage, Part A and Part B, plus extra services -most also include Medicare Part D prescription drug coverage. The amount you pay and your additional services vary by plan. Here’s a basic overview of the 6 types of plans.
- Health Maintenance Organization (HMO) Plans These Medicare Advantage Plans are available in some areas of the country. Most HMO’s require you to use a select network of doctors and health care providers. You are also required to use an in-network primary care physician to coordinate your overall care and refer you to any specialists as needed.
- Point of Service (POS) Plans This is a second managed care option that allows you to see out-of-network doctors at a higher cost than in-network doctors. Also, you can usually see in-network specialists without a referral from your primary care physician.
- Preferred Provider Organization (PPO) Plans This is a third type of managed care plan –available in local or regional areas. They don’t always require you to choose a primary care provider. However, seeing an out-of-network doctor usually costs more. Certain plans require you to pay a physician directly and then file a claim with your PPO.
- Private Fee-For-Service (PFFS) Plans PFFS plans are not managed care plans, therefore they work without health care provider networks. You can see any Medicare-eligible doctor or hospital that agrees to accept payment from your plan. Some plans require you to pay the doctor directly and then submit a claim to your insurance company, which then pays you back.
- Medical Savings Account (MSA) Plans These plans combine a High Deductible Health Plan (HDHP) and a special bank account fund (the MSA). You can use the money in this account to pay for your health care costs, however, only Medicare-covered expenses count toward your deductible. Once you’ve paid the deductible, the plan covers expenses normally covered under Medicare. MSA plans do not include Medicare Part D prescription drug coverage, so policy owners need to purchase a stand-alone Part D plan.
- Special Needs (SNPs) Plans These plans serve people with specific diseases or medical needs. This can include people with certain chronic diseases and conditions, some are for people who have both Medicare and Medicaid and some are for people who live in an institution (IE nursing home). The plans customize benefits, health care provider choices, and covered drugs to best meet the specific needs of the groups they serve.
You can read about the basics of Medicare Advantage plans here.
Looking to browse Medicare Advantage plans in your state? Click here. Or, if you’re ready to compare plans based on your exact zip code and prescription drugs, click here.