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What are the Medicare Advantage options?

Dr. Michael Roizen, MD
Internal Medicine

There are four different types of Medicare Advantage plans. Each Medicare Advantage plan covers Medicare Part A and Part B, and most include Medicare prescription drug coverage (Medicare Part D). Here’s how they differ.

- Health Maintenance Organizations (HMO) HMOs are sort of like a fraternity. They require you to use network doctors and hospitals. If you receive care outside the plan, you may have to pay the full cost. You also may need a referral to see a specialist.

- Preferred Provider Organizations (PPO) PPOs are like classrooms without assigned seats. They allow you to choose a doctor or hospital within or out of network. You don’t need a referral to see a specialist.

- Private Fee-for-Service (PFFS) PFFS plans allow you to visit any Medicare-approved doctor or hospital. Some PFFS plans have a network, and you may pay more to see an out-of-network doctor. The plan decides how much you pay for services, and doctors decide whether to treat you each time.

- Medical Savings Accounts (MSA) MSAs allow you to see the doctor of your choice and comes with a high deductible health plan and a bank account. You have to pay out-of-pocket costs before your coverage begins.

- Special Needs Plans (SNP) SNPs are like HMOs or PPOs, but only people with specific diseases or conditions can enroll. That’s because the benefits, provider choices, and drug coverage are tailored to fit the needs of this specific subset of participants.

 

For more detail on how the Medicare Advantage plans work, check your Medicare handbook or call your local Social Security office.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.