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.
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.