Types of Medicare Advantage Plans: HMO, PPO, PFFS, MSA, and SNP

HMO, PPO, PFFS, MSA and SNP are the five types of available Medicare Advantage Plans

  • Medicare Health Maintenance Organizations (HMO) Plans
  • Medicare Preferred Provider Organizations (PPO) Plans
  • Medicare Private Fee-for-Service Plans (PFFS) Plans
  • Medicare Medical Savings Accounts (MSA) Plans
  • Medicare Special Needs Plans (SNP) Plans

There are a variety of insurance companies providing all types of plans. Some provide most of these plan types, while many also provide multiple variations within each type. This makes a choosing a particular Medicare Advantage plan a rather difficult task; it can become very confusing.

HMO and PPO Medicare Advantage Plans

HMO and PPO are the most popular plan types of Medicare Advantage plans because people find them to be most suitable for their needs. The table below summarizes their features.

             HMO              PPO
A system of payers and providers (network) who work together through contracts to provide health care services A system of payers and providers (network) who work together through contracts to provide health care services
You are paying the full cost to use out-of-network services You are paying the higher cost to use out-of-network services
In most cases, you need to choose a Primary Care Physician (PCP) No need to choose a Primary Care Physician (PCP)
Referrals are necessary to visit a specialist Referrals are not necessary to visit specialists
Prescription Drug Coverage is available through the plan Prescription Drug Coverage is available through the plan
A limit on out-of-pocket costs for network providers – not to exceed more than $6,700 per year A limit on out-of-pocket costs for network providers – not to exceed more than $6,700 per year

 

PFFS, MSA, and SNP Medicare Advantage Plans

The next table summarizes the features of other plan types.

             PFFS      MSA              SNP
The plan decides how much it will pay to providers and how much the beneficiary will pay. There is no contract, service is done on a case-by-case basis Combines a high-deductible health plan with a medical saving account Special need plan for people who either (a) live in certain institutions (like nursing home), or (b) eligible for Medicare and Medicaid, or (c) with specific chronic or disabling conditions, such as HIV/ AIDS
You can go to any Medicare-approved doctor or hospital that accepts the plan’s payment terms and agrees to treat you. If the plan has a network, you can also see any of the network providers Some plans have preferred providers at a lower cost Network of providers
No need to choose a Primary Care Physician (PCP) No need to choose a Primary Care Physician (PCP) May need to have a Primary Care Physician (PCP)
No referrals are necessary No referrals are necessary Referrals are necessary
May include Prescription Drug Coverage Prescription Drug Coverage is through Medicare PDP Prescription Drug Coverage is through the plan
A limit on out-of-pocket costs for network and non-network providers – not to exceed more than $6,700 per year

 

How Liberty Medicare Can Help?

We represent carriers with all types of Medicare Advantage plans: not only the familiar HMO and PPO plans, but the less known Special Needs Plans (SNPs) and Medicare Savings Accounts Plans (MSA) as well.

Special Needs Plans (SNPs) are for people having specific chronic conditions (like diabetes, congestive heart failure, or a mental health condition), living in an institution (like a nursing home), or having both Medicare and Medicaid. The plans are tailored to the needs of the groups they serve.

Medicare Savings Account Plans (MSA) do not require the use of a network of medical providers. The beneficiary can go to any doctor or medical facility that accepts Medicare and the insurance carrier’s terms and conditions of payment. The monthly premium is normally very low. An MSA may be a suitable alternative to Medicare Supplement (Medigap) for people who either cannot afford Medigap, or will not be accepted because of Medical Underwriting.

Liberty Medicare represents many well-known Medicare Advantage providers doing business in Delaware, Illinois, Maryland, New Jersey, New York, Ohio, Pennsylvania, and Virginia.  Learn more about all benefits of working with Liberty Medicare.

All of our services are offered to you at no cost. To observe real quotes from Medicare Advantage providers, please fill out our Medicare Advantage Quote form. You also may give us a call at 877-657-7477, and you will be connected to a licensed agent/broker.