Medicare Advantage Plans

Medicare Advantage Plans - Doctor Holding ClipboardMedicare Advantage plans offer benefits that aren’t available through Original Medicare parts A and B. Advantage plans are offered through private insurance companies and can be customized for your own unique needs. There are two common types of Medicare Advantage plans, Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs).  Other Medicare Advantage plans include Private Fee-for-Service Plans (PFS), Special Needs Plans (SNP), and Medicare Medical Savings Account (MSA) plans.

The important difference between them is where you can get covered treatment. A Preferred Provider Organization has what is commonly referred to as a network of coverage. This means that there is a network of preferred facilities and physicians that are pre-approved for coverage with your plan. As long as you stay within this network, you will not incur any unexpected costs from covered procedures and examinations.

A Health maintenance Organization operates in a slightly different way. HMOs also have a network of pre-approved service providers that will be covered within your plan, however the one main difference is that you must elect a primary care physician. This primary care physician acts as your personal doctor, but also as your health care coordinator. If you ever needed to see a specialty doctor who was not in your HMO plan network, your primary care physician could offer you a referral if they deemed it necessary. You may need to obtain a referral from your primary care physician in order for the service to be covered. By knowing what doctors are important to your healthcare, you can make a much more informed decision about what plan will serve you best.