There are different types of Medicare Advantage Plans.
A Medicare Advantage Plan, also known as Medicare Part C, is an alternative to Original Medicare (Part A and Part B) offered by private insurance companies approved by Medicare. These plans are required to provide at least the same level of coverage as Original Medicare but often include additional benefits, such as vision, dental, hearing, and wellness programs. Many Medicare Advantage Plans also include prescription drug coverage (Part D), combining multiple aspects of care into a single plan with one insurance card.
Medicare Advantage Plans operate under a managed care model, typically as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). This means members may need to use a network of doctors and hospitals and may need referrals to see specialists, depending on the plan. Premiums, copayments, and coverage details can vary between plans and providers, making it important for enrollees to compare options based on their health needs, budgets, and preferred healthcare providers. Below are the different types of plans.
Health Maintenance Organization Plans (HMO)
A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. In most HMOs, you can only get your care from doctors or hospitals in the plan’s network (except in emergencies).
Preferred Provider Organization (PPO) Plan
A Medicare Advantage Plan that provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. PPOs have network doctors and hospitals but you can also use out-of-network providers, usually at a higher cost.
Private Fee-For-Service (PFFS) Plan
A Medicare Advantage Plan in which you may go to any Medicare-approved doctor, hospital and provider that accepts the plan’s payment, terms and conditions and agrees to treat you – not all providers will. If you join a PFFS Plan that has a network, you can see any of the network providers who have agreed to always treat plan members. You will usually pay more to see out-of-network providers.
Point of Service (POS) Plan
A type of Medicare Advantage Plan available in a local or regional area which combines the best feature of an HMO with an out-of-network benefit. Like the HMO, members are required to designate an in-network physician to be the primary health care provider. You can use doctors, hospitals, and providers outside of the network for an additional cost.
Special Needs Plan (SNP)
A Medicare Advantage Plan that has a benefit package designed for people with special health care needs. Examples of the specific groups served include people who have both Medicare and Medicaid, people who reside in nursing homes, and people who have certain chronic medical conditions.
General disclaimers
This website is operated by MediLife & Health, LLC. Nothing contained herein constitutes nor is intended to constitute an offer, inducement, promise, or contract of any kind, or a recommendation to purchase insurance from any particular insurance company at any particular level of benefits or plan design. MediLife & Health, LLC is not an insurance company. In offering this website, MediLife & Health, LLC is required to comply with all applicable federal laws, including the standards established under 45 CFR 155.220(c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information. MediLife & Health, LLC intends that the general and insurance specific information contained on this web site be accurate and reliable, however, MediLife & Health, LLC makes no warrantees or representations as to the completeness, accuracy or timeliness of the web site materials. The company will not be liable for any damages of any kind from or relating to the use of, or reliance upon, results obtained by users from the web site and related services.
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The benefits mentioned are Special Supplemental Benefits for the Chronically Ill (SSBCI). You may qualify for SSBCI if you have a high risk for hospitalization and require intensive care coordination to manage chronic conditions such as Chronic Kidney Diseases, Chronic Lung Disorders, Cardiovascular Disorders, Chronic Heart Failure, or Diabetes. For a full list of chronic conditions or to learn more about other eligibility requirements needed to qualify for SSBCI benefits, please refer to Chapter 4 in the plan’s Evidence of Coverage.
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.
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