Medicare Advantage Plans have inpatient, outpatient, and prescription drug coverage all within one package. Each Medicare Advantage Plan has its own appeal, as every plan has special features that suit a policyholder’s needs and values. Common Medicare Advantage plans are Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), Private Fee-for-Service (PFFS), and Special Needs Plans (SNPs).
Plans can be compared by which ones allow seeing out-of-network providers, require choosing a doctor and getting referrals, cover prescriptions, and how they save you healthcare costs.
Preferred Provider Organization (PPO)
PPO plans cover out-of-network treatment for a higher cost. You don’t have to choose a primary care physician or get a referral to see a specialist. This plan also covers prescription drugs.
PPO plans:
- Let you see specific doctors at a greater discount
- Have premiums lower than Medicare Supplement Plans
- Let you pay as you go with copays and medical services
Health Maintenance Organization (HMO)
HMO plans are the most basic Medicare Advantage Plans. You have to stay within the network for coverage because this plan will not cover you if you seek care outside the network. You have to choose a primary care physician, and your chosen doctor will have to refer you when you need to see a specialist.
Private Fee-for-Service (PFFS)
PFFS plans set the amount you pay for treatment. These plans also have the most freedom when it comes to who you can get treatment from. Medicare-approved doctors, hospitals, and other healthcare providers can treat you as long as they accept the payment terms set by your plan. And for the plans with specified networks, you can get out-of-network treatment at a higher cost.
You don’t need a primary care physician’s referral. You don’t even have to choose a primary care doctor. Prescription drug coverage is not a guarantee with every policy – if the only PFFS plan available to you doesn’t have drug coverage, you can enroll in a Medicare prescription drug plan separately.
Medicare Savings Account (MSA)
MSA plans provide a savings account. You can get out-of-network treatment at higher costs. Specialist referrals are not needed, nor do you have to choose a primary care physician. However, you will have to enroll in Part D separately if you want prescription drug coverage.
This policy can be premium-free. The money in the savings account rolls over into the next year, and it isn’t taxed as long as it covers Medicare-related expenses.
Special Needs Plan (SNP)
Special Needs Plans are limited to those either living in an institution, meet both Medicare and Medicaid eligibility requirements or have a chronic and disabling condition.
These plans do require choosing a primary care doctor, and you will need a referral to see a specialist. All SNPs must have prescription drug coverage.
Availability
Some Medicare Advantage policies may not be available in your area. But with these preferences in mind, we can help you find exactly the plan you need. At Cornerstone Senior Advisors, you’re at the forefront of our minds. Call us at 316-260-3331.