Types of Medicare Advantage Plans

Advantage Plans take a great deal of investigative research to find the best plan for your situation. Advantage Plans are divided into basic types of plans. You will probably be familiar with some of these types of insurance. They include:

  • HMO Plans; stands for Health Maintenance Organization Plans. In these types of plans people are required to use providers from the plan's provider network. In general patients will need a referral to see a specialist.
  • PPO Plans; stands for Preferred Provider Organization Plans. These plans are similar to HMOs except that the patient usually does not need a referral to see a specialist. Like an HMO, seeing providers outside of the network usually costs the patient more in out-of-pocket expenses.
  • HMOPOS Plans; stands for HMO Point-of-Service Plans. A HMOPOS incorporates both the low costs of the HMO and the flexibility of offering a Point-of-Service option. This allows the patient to see other doctors and providers outside the provider network but the costs will be much higher.
  • MSA Plans; stands for Medical Savings Account. These plans include both a high deductible plan and a Medical Savings Account. Medicare then deposits monies into the savings account to help pay for health care costs.
  • PFFS Plans; stands for Private Fee-for-Service Plans. In these plans patients can use any provider that accepts the patient's insurance and terms. The company determines how much they will pay and how much the patient will pay for services.
  • SNP Plans; stands for Special Needs Plans. These plans are designed for Medicare and Medicaid individuals who live in long-term care facilities. Special Needs Plans are usually very limited in the types of people they will service and the areas where they are available.

Beyond this is gets even more complicated because Advantage Plans are further divided into what types of care they provide, the costs of deductibles, co-pays and coinsurance. The plan can also included or excluded any number of other variables. The good news is that each company will also have a capable insurance agent who can help you understand what their plan does or doesn't include.

There are also three other types of Medicare plans to be aware of. These are:

  • Medicare Cost Plans. A Medicare Cost plan is similar to an HMO except that out-of-network providers are still covered by Original Medicare.
  • PACE Program, Stands for Programs of All-inclusive Care for the Elderly PACE is only available in limited places. The goal of PACE is to offer medical and social services to very frail elderly people who want to remain living in their own homes. Qualifications for joining PACE are determined by each state that has decided to participate in the program.
  • Special Project/Pilot Programs. These are special programs that are targeted towards improving the quality of care and affordability of Medicare. Generally speaking, these programs are only offered to a limited number of people with certain types of chronic illnesses. However, it is worth investigating Pilot Programs because they can offer some excellent incentives to patients willing to participate in the programs.