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Medicare Advantage Plan Types

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You have six plan types to choose from.

There are six Medicare Advantage plan types. The main differences between them are provider access and cost sharing   .

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 Plans (SNP)

 

Other Plans

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

Coordinated care plans

Coordinated care plans contract with a network    of providers   . Each plan has its own network. In general, your out-of-pocket costs will be lower for services you receive from network providers than for the same services from non-network providers.

 

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 plans

Health Maintenance Organization (HMO)    plans usually pay only for care you receive from providers in the plan network.

  • Primary care provider coordinates your care
  • May require you to get a referral to see specialists or other providers
  • You may have to pay for the entire cost of care received from out-of-network providers.

Point of Service plans

Point of Service (POS)    is a benefit option offered with some HMO plans.

  • Usually covers care received from both network and out-of-network providers
  • May allow you to see a specialist without a referral
  • You may pay more for care received from out-of-network providers
  • Out-of-network coverage may be limited to specific services or to a dollar amount.

Preferred Provider Organization plans

Preferred Provider Organization (PPO)    plans will pay a portion for care that you receive outside the plan network.

  • Covers care received from both network and out-of-network providers
  • Allows you to see a specialist without a referral
  • You may pay more for care received from out-of-network providers.

Special Needs Plans

Special Needs Plans (SNP)    are for individuals in four categories:

  • People who are entitled to both Medicare and a state Medicaid    program(also known as "dual eligible")
  • People with severe or disabling chronic conditions
  • People who live in an institution, and
  • People who require the same level of care as those who live in an institution.

Special Needs plans:

  • May be an HMO, POS or PPO plan
  • 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 plans

Medical Savings Account (MSA)    plans combine a high-deductible health plan with a bank savings account.  

  • Money from Medicare is deposited into the account each year
  • You may use the money—tax free—to help pay for qualified health care services
  • Unused funds remain in the account and accumulate year to year
  • Funds may be invested in certain cases, if you choose
  • You may receive care from any provider you choose
  • Does not include prescription drug coverage
  • Does not charge a premium.

Private Fee-For-Service plans

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.

  • May cover services you receive from any provider in the U.S. who accepts Medicare
  • Premiums and deductibles vary
  • May offer prescription drug coverage
  • May cover additional services, like routine eye and hearing exams.

What do you want to do next?

 

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