Medicare Advantage Plans

Just like private health insurance, there are many types of Medicare Advantage Plans. Each plan offers different benefits and will appeal to a variety of people dependent upon their health concerns. Further, similar to private health insurance, Medicare Health Plans are offered as HMO, PPO, PFFS, MSA & SNP plans.

How To Compare Medicare Advantage Plans

Medicare & Medicaid rates all Medicare Advantage and drug plans each year based on quality, performance, and customer service. They are rated on a scale of 1-5, with a 5-star rating being excellent and a 1-star rating being poor.

HMO Medicare Advantage Plans

An HMO (Health Management Organization) Medicare Advantage Plan provides its members with a network of doctors, hospitals and other medical providers from which they are permitted to get care. The plan members must seek medical treatment within their plan network. The only exception is the plan member is permitted to seek emergency medical treatment outside of their plan network.

Once enrolled in an HMO Medicare Advantage Plan, the member will select their primary care physician who will manage the member’s medical care. If the member requires medical treatment from a specialist the primary care physician will coordinate appointments among a network of specialist. The plan member may select any primary care physician of their choosing so long as the primary care physician is within the HMO network.

The major benefits of an HMO as compared to a PPO is the member usually has lower out of pocket expenses, deductibles and co-payments.

PPO Medicare Advantage Plans

A PPO (Preferred Provider Network) Medicare Advantage Plan allows members to seek medical treatment from both in-network and out-of-network medical providers. Some medical expenses incurred by out-of-network providers may be covered by the plan-although at a lower rate than the in-network medical providers. This gives the member more flexibility in selecting their medical care. Additionally, members of PPO Medicare Advantage Plans may seek medical treatment from a specialty medical provider without first obtaining approval from their primary care physician.

PFFS Medicare Advantage Plans

A PFFS (Private Fee For Service) Medicare Advantage Plans allows members to obtain treatment from any medical provider who accepts Original Medicare. The PFFS Medicare Advantage Plans set a fee schedule on how much the doctor is permitted to charge and what part of the charge will be covered by the plan. However, these plans are not popular because this is no requirement upon the medical provider to treat members covered by these types of plans. If the medical provider feels the fee schedule is too low they may choose not to provide treatment to the plan member.

MSA Medicare Advantage Plans

A MSA (Medical Savings Account) Advantage Plan is a high deductible health plan. These plans are similar to traditional HSA (Health Savings Accounts) or High Deductible Health Insurance Plans. The insurance will kick in after a high deductible is met.

SNP Medicare Advantage Plans

A SNP (Special Needs Plan) Medicare Advantage Plan is reserved for people who have unique health issues. These plans can be in the form of either HMO or PPO Plans. Example of conditions that may qualify for SNP Medicare Advantage Plans include nursing home residents, Medicaid recipients or other people with disabling health conditions.