Different Types of Medicare Advantage Plans
Medicare Advantage (MA) is a health plan offered by a private insurance company annually contracted with Medicare to providing your Part A, B, and usually Part D (MAPD) benefits - think of it as "outsourced" Medicare. Some carriers offer MA only coverage for Veterans or others with prescription coverage. Medicare pays companies of either type a subsidy to offset "costs" of processing referrals, authorizations, managing your care, or paying your claims. Subsidies vary by county, state, or region. More Advantage plans are using national networks of contracted doctors providing greater access if/when you travel and require non urgent-emergent care. ALL plans treat Urgent Care and Emergency Care as in-network care.
Medicare Advantage Plans include the following:
Many insurance companies now use national contracts for their medical networks; some allow access to any contracted network provider throughout the nation without referral. Med Supp advertisers infer this is not the case. Please have your agent review your needs.
Health Maintenance Organization (HMO) & (HMO-POS) Plans
In most HMO Plans, you can only go to doctors, other health care providers, or hospitals in the plan's network, except in an emergency. You may also need to get a referral from your primary care doctor to see specialists. There are variations of HMO plans in some service areas, such as Open Access or HMO-POS, offering expanded in network service areas or limited/capped out of network benefits.
Preferred Provider Organization (PPO) Plans
A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network.
Private Fee-for-Service (PFFS) Plans
A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
Medicare Special Needs (SNP) Plans
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO, HMO-POS, or PPO). Medicare SNPs limit membership to people with dual eligibility (Medicare and Medicaid) DSNPs, specific diseases CSNPs, or institutional living status ISNPs. Each tailors benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Companies receive higher subsidies for these plans.
These definitions are directly from www.medicare.gov
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