Types of Medicare Advantage Plans

Agents commonly present these options to help beneficiaries manage costs and care:

• Health Maintenance Organization (HMO): Requires using in-network doctors and hospitals (except emergencies) and usually necessitates a referral to see specialists. These often feature lower premiums.
• Preferred Provider Organization (PPO): Offers flexibility to use doctors outside the network, though out-of-pocket costs are higher. No referrals are required for specialists.
• HMO Point-of-Service (HMOPOS): A hybrid plan that functions like an HMO but allows limited, higher-cost access to out-of-network providers.
• Special Needs Plans (SNPs): Tailored plans for individuals with specific chronic conditions, dual eligibility (Medicare/Medicaid), or those in institutional care.
• Private Fee-for-Service (PFFS): The plan determines payment rates for providers, and members can see any Medicare-approved provider who accepts the plan's terms.
• Medical Savings Account (MSA): Combines a high-deductible health plan with a bank account funded by Medicare to pay for healthcare costs.