What is Medicare Advantage Plans?

• Also called ‘Plan C’ health plan run by private insurance companies that are approved by Medicare (government program). Medicare Advantage Plans include Part A & Part B, and usually Part D (Medicare prescription drug coverage for an extra cost) 

Types of Medicare Advantage Plans:

Health Maintenance Organization (HMO) Plans

• A type of health insurance plan with which you can only go to the doctors and hospitals that have agreements with this plan. In case of emergency you can go to any health care service, even if it has no agreement with HMO plans. Your primary care doctor should give a referral before you see a specialist.

Proffered Provider Organization (PPO) Plans

• Medicare Advantage Plan which allows you to pay less if you use hospitals, doctors that belong to the network in that regional area. You pay additional cost if you use doctors and hospitals outside of the network.

Private Fee-for-Service (PFFS) Plans

• Medicare Advantage Plan that allows you to go to any medicare - approved doctor or hospital that agrees and accepts to treat you under the plan's payment terms. This is fee-for-service plan that decides how much you must pay for services.

Special Needs Plans (SNPs) Plans

• Medicare Special Needs Plans are a type of Medicare Advantage Plan designed for certain types of people with Medicare. Some Special Needs Plans are for people with certain chronic diseases and conditions, some are for people who have both Medicare and Medicaid, and some are for people who live in an institution such as a nursing home.

HMO Point-of-Service (HMO-POS) Plans

• These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.