What Types of Medicare Advantage Plans Are There?
You've probably noticed that there are different types of Medicare Advantage plans. The most common types of Medicare Advantage plans might seem familiar to you if you’ve had group health insurance before.
For example, take health maintenance organizations, or HMOs. This type of plan typically has a provider network.
Usually you’ll have to get your care from a provider in that network.
You will also have to Choose a primary care provider.
You will need to get referrals from the primary care provider to see a specialist.
Then there are preferred provider organizations, or PPOs. This type of plan might also have a provider network.
Usually you don’t have to get your care from a network provider, but you generally have a higher copayment or coinsurance if you go out of network.
And you don’t have to choose a primary care provider.
You don’t generally have to get referrals from the primary care provider to see a specialist
Another kind of Medicare Advantage plan you might want to know about is a Private Fee-for-Service plan, or PFFS.
One unique feature of this type of plan is its flexibility. You might have the option of using a provider network, or staying independent of a network.
With a PFFS plan that has a provider network, you won't have to check every time to see if your doctor accepts the plan's payment terms. Providers in the network have agreed to the plan's terms, and to treat you. You can also see doctors outside the network, but you have to check to make sure they accept the plan's terms.
On the other hand, with a PFFS plan without a provider network, you have the freedom to choose any doctor you want. However, you will need to check with each provider before every visit to make sure they accept the plan's payment terms.
Then there are Special Needs Plans, or SNPs. This is a special type of Medicare Advantage plan that's tailor-made for a certain kind of health condition.
You might qualify for an SNP if you live in a nursing home or need nursing care at home – or if you have an illness such as:
- Diabetes mellitus
- HIV/AIDS
- Stroke
- Cancer
- Dementia
There are many other illnesses that may qualify you for an SNP.
In most cases, you'll need to see doctors and specialists in the plan's provider network. Your plan will typically coordinate your care.
Navigating through different medicare plans can be complicated. At eHealth, we are here to help. If you have questions, check our website at [ Ссылка ]. Thanks for watching!
