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Did you know there are several different types of Medicare Advantage plans? You might have a choice of several kinds, such as:
We’ll take a look at each of these types and more, so you can compare Medicare Advantage plans while keeping your needs in mind.
Let’s start with a quick overview of the Medicare Advantage (Part C) program before you compare Medicare Advantage plans. Medicare Advantage gives you an alternative way to get your Original Medicare (Part A and Part B) benefits. Under Medicare Advantage, you receive these benefits through a private insurance company that contracts with Medicare. You’re still in the Medicare program, but now a private company administers these benefits and delivers them to you. The exception is hospice care, which is still covered directly under Part A.
Many Medicare Advantage plans go beyond Original Medicare coverage. For example, most plans include prescription drug coverage, which is limited under Part A and Part B. Some plans include routine dental coverage, SilverSneakers fitness programs, and/or other benefits.
As you compare Medicare Advantage plans, please note that you still have to pay your monthly Part B premium, along with any premium the Medicare Advantage plan might charge.
To help you compare Medicare Advantage plans, here are quick descriptions of the different types. Please note that every type of plan might not be available in your area.
Health Maintenance Organization (HMO) – You might be familiar with this type of plan if you were ever covered by an employer through an HMO. Medicare Advantage HMO plans typically:
HMOs often have lower premiums than other types of Medicare Advantage plans.
Preferred Provider Organization (PPO) – Again, some employer group plans are PPOs, so you might know something about this type of plan. Medicare Advantage PPO plans typically:
Health Maintenance Organization Point-of-Service (HMO-POS) –This type of plan is similar to an HMO, but may let you get care outside the plan network. Medicare Advantage HMO-POS plans typically:
Private Fee-for-Service (PFFS) –This type of plan sets its own payment structure. The plan decides how much it will pay its Medicare providers, and how much you will pay as a patient. Here are some things to know about PFFS plans:
Special Needs Plans (SNPs) – This is a special kind of Medicare Advantage plan that’s designed to serve people with specific health conditions, or meet certain other qualifications. SNP plans typically:
Who’s eligible for a Medicare SNP?
First, you must be enrolled in both Medicare Part A and Part B (as with any type of Medicare Advantage plan). You must also live in the plan’s service area.
You might qualify for an SNP if any of the following applies to you.
Medicare Medical Savings Accounts (MSAs) – This is a special kind of Medicare Advantage plan that charges a high deductible, but sets up a bank account for you to use for your health-care costs before you pay your deductible. SNP plans typically:
Now that you’ve read a quick overview of several types of Medicare Advantage plans, you might be wondering how to choose the type that may work for you. Here are some questions you might want to answer before you compare Medicare Advantage plans:
**Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether the plan will cover an out-of-network service, you or your provider are encouraged to ask for a pre-service organization determination before you receive the service. Please call the plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.