Medicare Advantage, also known as Medicare Part C, is a good alternative for people that can’t afford a Medicare Supplement Insurance (Medigap) plan. Medicare Advantage plans, however, have some restrictions you won’t find with a Medigap plan. One of the main restrictions of a Medicare Advantage plan is the plan’s network. Let’s take a look at the different types of Medicare Advantage plans and their networks.
The Types of Medicare Advantage Plans and Their Networks
Health Maintenance Organization (HMO) plans
In a Health Maintenance Organization (HMO) plan, you can only go to doctors and hospitals in your plan’s network. In order to see a specialist, you’ll need to receive a referral from your primary care physician.
Preferred Provider Organization (PPO) plans
In a Preferred Provider Organization (PPO) plan, doctors and hospitals in your plan’s network cost less. If you use a doctor or hospital outside of the network you’ll pay more.
Special Needs Plans (SNPs)
Special Needs Plans (SNPs) are meant for those that require specialized health care. Examples of people that might use an SNP are people who have both Medicare and Medicaid or live in a nursing home. If you’re not sure if you might benefit from being in an SNP, contact us and we can help guide you through the process.
Private Fee-for-Service (PFFS) plans
A Private Fee-for-Service (PFFS) plan allows you to go to any doctor or hospital as long as they accept the plan’s payment terms. A PFFS plan is similar to Original Medicare in that regard. Essentially, the plan sets forth how much it will pay the doctor and how much you must pay for your medical services, and then the doctor/hospital decides if it will accept the plan.
Medical Savings Account (MSA) plans
A Medical Savings Account (MSA) combines a high-deductible
health plan with a bank account. You may be familiar with the concept of MSAs if your employer offered them during your career, although a Medicare Advantage MSA is a little different. If you have an MSA, Medicare deposits money into the account for you. This money is then available for your use for health care during the year. Note: the amount of money Medicare deposits is usually less than the deductible.
HMO Point-of-Service (HMOPOS) plans
An HMO Point-of-Service (HMOPOS) plan is an HMO plan that allows you to get out-of-network care for a higher copayment or coinsurance.
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* Montana Life Group is not connected with or endorsed by the U.S. Government or the federal Medicare program.
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