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Different Types of Medicare Advantage Plans

Medicare Advantage is a health plan offered by a private insurance company annually contracted with Medicare to providing your Part A, B, and usually Part D benefits - think of it as "outsourced" Medicare. Medicare pays these companies a subsidy to offset "costs" of processing referrals, authorizations, managing your care, or paying your claims. Subsidies vary by county, state, or region. Some Advantage plans use a national network of contracted doctors providing greater access if/when you travel and require non urgent-emergent 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. Some Med Supp advertising infers 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

By contacting the phone number on this website you will be directed to a licensed agent.

Medicare Education
  • Medicare Simplified
  • Are You Eligible for Medicare?
  • Medicare: What you need to know
  • Medicare Advantage Plans
  • Different Types of Medicare Advantage Plans
  • Part D Prescription Drug Plans
  • What is Medicare Supplement (Medigap) Insurance?
  • Compare Medicare Supplement plans side by side

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The agents and agency are not affiliated with nor endorsed by any government agency. Not associated with the Federal Medicare program. By contacting us, you may be offered insurance policies to purchase. This is a solicitation for insurance plans by a licensed insurance agent/producer. Per CMS requirements, all calls to our 800# are recorded. In some markets, we do not offer every plan available. Any information provided is limited to those plans offered in your area. Please contact Medicare.gov or 1–800– MEDICARE to get information on all of your options.

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