The Importance of Insurance

Medicare Advantage Plan: Different Types Of Medicare Advantage Coverage Plans You Can Choose

23 April 2021

Katrina Terry

Also referred to as Medicare Part C, a Medicare Advantage plan enables you to receive the same benefits you enjoyed from Medicare Parts A&B under an alternative plan administered by a private insurance company that Medicare has contracted with.

There are five different types of Medicare Advantage plans you can choose from, so it's essential to learn about what the different plans entail. Here is a detailed review of all five Medicare Advantage plans to help you decide which one applies best to you.

1. Preferred Provider Organization (PPO)

Under a PPO Medicare Advantage plan, you don't get limited to the health care providers recommended under the plan's network. Thus you are free to utilize any health care provider of your choosing.

However, it is essential to note that when you use a health care provider not recommended under the plan's network, the costs are higher. For instance, if you use a health care provider not listed on the plan's networks, your coinsurance and copayments costs will be higher than if you used a health care provider on the plan's network. Thus, if you choose this plan, it is advisable to try and stick to the network of health care providers recommended by the insurance company to minimize costs.

2. Health Maintenance Organization (HMO)

With a Medicare Advantage HMO plan, you can only use the health care providers listed on the plan's network. If you use a health care provider that is not on the plan's network, the coverage is not applicable. However, sometimes you may get an exception for medical emergencies and a few other specialized treatments, such as dialysis.

However, suppose you need to get specialist treatment from a health care provider that i snot on the plan's network. In that case, it is advisable to seek an HMO plan with an optional Point of Service (POS). The POS option enables you to receive specialized treatment outside of the plans' networks under the HMO plan. However, the costs will be considerably higher.

3. Private Fee-For-Service (PFFS)

For this type of Medicare Advantage plan, the plan has a contractual payment structure with out-of-network health care providers. 

PFFS plans have a network of healthcare providers who have already agreed to the payment terms of the PFFS plan, and thus they provide treatment to any person with PFFS coverage. 

However, if you receive treatment from a health care provider who has not accepted the payment terms of a PFFS plan (out-of-network), the PFFS plan will not cover the treatment costs. Hence, they have to sign a contract agreeing to the payment terms and conditions of the PFFS plan every time you get treated.

4. Special Needs Plan (SNP)

Medicare Advantage SNP plans are only for people with special needs whod fit in one of the three categories of the plan. The three categories are:

• Chronic Conditions: This category is only for people with a chronic ailment such as diabetes or cancer.

• Dual Eligibility: This category is for persons who have both Medicaid and Medicare.

• Institutional SNP: To qualify for this plan, you must enroll in an institution such as a nursing home.

Unlike the other Medicare Advantage plans, the main benefit of an SNP is that you automatically get prescription drug coverage.

5. Medicare Savings Account (MSA)

An MSA is a plan that has a high deductible, and it also comes with a savings account. Medicare deposits money meant for medical treatment into the savings account every year. The deductible is the amount of money the plan decides as the limit for medical costs deposited in the savings account.

When you reach the deductible limit, the plan no longer deposits money in the account but instead directly pays for your medical costs for the rest of the year.

Contact a company like Franklin Benefits Group to learn more.

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