Medicare Advantage Plan Types

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You have six plan types to choose from.

 

Congress added Medicare Advantage plans to give you more coverage choices. That’s why you’ll find different kinds of plans in this category.

There are six Medicare Advantage plan types. The main differences between them are provider access and cost sharing. Coordinated care     plans have stricter rules and generally cost you less. Other plan types have more flexibility and may cost more.

If you’re ready now, you can view details about Medicare Advantage plans offered in your area by UnitedHealthcare.

Coordinated Care Plans

Health Maintenance Organization (HMO) plans
Point of Service (POS) plans
Preferred Provider Organization (PPO) plans
Special Needs Plan (SNP)

 

Other Plans

Private Fee-For-Service (PFFS) plans
Medical Savings Account (MSA) plans

Coordinated care plans

Four of the six Medicare Advantage plan types are coordinated care plans. These are also known as managed care plans.

Coordinated care plans contract with health care providers     to provide care to plan members. These providers make up the plan’s network    . Each plan has its own network. In general, you will pay less out-of-pocket for services from providers in your Medicare Advantage plan’s network.

 

Network

Hospital

Doctor

Doctor Plan

Plan pays a bigger share for services inside the network.

Drugs

You pay all or a larger part of the cost of services outside the network.

Health Maintenance Organization plan

Health Maintenance Organization (HMO)     plans usually pay only for care you receive from providers in the plan network. You choose a primary care doctor within the network who helps coordinates your care. If you go outside the plan network for care, then you may have to pay the entire cost out-of-pocket. Also, some plans may require that you get a referral from your primary care doctor to see specialists or other providers.

Point of Service Plan

Point of Service (POS)     is a benefit option offered with some HMO plans. It allows you to see either in-network or out-of-network providers for care. Generally, you will pay more for out-of-network care than you would if you received the same service from an in-network provider. The plan may limit out-of-network coverage to specific services or to a dollar amount. Many plans allow you to see a specialist without a referral.

Preferred Provider Organization plan

Preferred Provider Organization (PPO)     plans will pay a portion for care that you receive outside the plan network. But they usually pay more if you get care within the network. PPO plans allow you to see a specialist without a referral.

Special Needs Plan

Special Needs Plans (SNP)     are for individuals in three categories: 1) People who are entitled to both Medicare and a state Medicaid     program, 2) people with severe or disabling chronic conditions, and 3) people who live in a long-term care facility or who require an institutional level of care. An SNP plan can be an HMO, POS or PPO plan. All SNP plans must include prescription drug coverage.

Other Medicare Advantage plans

Two Medicare Advantage plan types offer nearly complete freedom of choice in health care providers. On the flip side, you take on more responsibility for your health care expenses.

Medical Savings Account plan

Medical Savings Account (MSA)     plans combine a high-deductible health plan with a bank savings account. Money from Medicare is deposited into the account at the beginning of each year. You can use the money—tax free—to help pay for qualified health care services from any provider.

The plan covers your health care costs after you meet an annual deductible. The maximum annual deductible is set by law and is updated every year. If your savings account runs out before the annual deductible is met, then you must pay the difference out-of-pocket. Alternatively, any unused funds remain in the account and accumulate year to year.  

MSAs do not charge premiums and do not include prescription drug coverage. You must buy a standalone Medicare Part D prescription drug plan if you want coverage for prescription drugs.

Private Fee-For-Service plan

Private Fee-For-Service (PFFS)     plans may or may not have contracted provider networks, prior authorizations, and referral requirements, depending on whether they are network or non-network plans. Most PFFS plans are non-network plans that will cover services you receive from any provider in the U.S. who accepts the plan’s terms, conditions and payment rates.

Premiums and deductibles vary among PFFS plans. Also, some offer prescription drug coverage and some don’t. Many PFFS plans cover additional services, like routine eye and hearing exams.

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