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What Are The 3 Types Of Medicare Advantage Plans

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Written by: Benavest

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Medicare

February 6, 2020

Medicare Advantage Summary

Medicare Advantage are plans from a private company contracted with the government to distribute Medicare benefits. Medicare Advantage plans will cover Part A and Part B, most plans will also cover Part D(your prescription drug cost). These plans can go beyond Original Medicare by providing extra benefits, such as dental and vision insurance and wellness/fitness programs.

 

Let’s go over the 4 different types of Medicare Advantage Plans to find the key differences/benefits of each plan.

 

Health Maintenance Organization (HMO)

HMO plans are very common Medicare Advantage plans. They have strict rules for where the plan can work but have lower premium cost in return:

 

  • They come with a network of doctors and hospitals
  • You are required to use this network for your insurance to work
  • You are required to choose a primary care provider
  • Referrals are required to see a Specialist
  • Premiums are lower in cost
  • Have POS options to use out-of-network providers at a higher cost

 

Preferred Provider Organization (PPO)

PPO plans are very common as well. They are much less strict in their network rules but cost significantly more than HMO:

 

  • They come with a network of doctors and hospitals
  • You are not required to use this network for your insurance to work
  • You are not required to choose a primary care provider
  • Referrals are not required to see a Specialist
  • Premiums are higher in cost
  • If the plan covers prescriptions, you can not sign up for Part D

Speak With A Medicare Specialist

Private Fee-for-Service (PFFS)

PFFS plans are unique with their payment structures. The plan will construct cost structure based on certain criteria you provide:

 

  • They come with a network of doctors and hospitals based upon if the doctor(s) accepts the plans payment plan.
  • Will cost more to see outside the network of the plan
  • You are not required to choose a primary care provider
  • Referrals are not required to see a Specialist

 

Other Medicare Options Available

Medical Savings Accounts (MSA)

MSA plans are less common than the others. The insurance company will set up a bank account and deposit money into it for your medical cost. This money will not be taxed on any healthcare needs and can be used for non-medicare healthcare needs as well, if the money is used on non-healthcare related purchases this money will be taxed.

 

Changing Medicare Advantage Plans

The Medicare Advantage Enrollment Period is from January 1st to March 31st. Within this time you are able to switch your plan to another, but please consult a Medicare Specialist to help you decide on what plans may fit your current needs the most.

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