Private companies approved by the federal government provide Medicare Advantage coverage (also known as Part C or MA Plans). The list below explains what each plan type covers:

Health Maintenance Organization (HMO) plans

have in-network providers. If you go to an out-of-network provider, you may have to pay the full cost of services.
don’t offer drug coverage unless you select an HMO plan that includes Part D during enrollment.
may require you to select a primary care doctor.
may require you to have a primary care doctor’s referral to see a specialist.
don’t cover emergency care, out-of-area urgent care, and out-of-area dialysis.
may require you to get prior approval for medical services.

Preferred Provider Organization (PPO) plans

have in-network providers. You do have the option to go to an out-of-network provider, and services will cost more.
don’t offer drug coverage unless you select a PPO plan that includes Part D during enrollment.
don’t require you to select a primary care doctor.
may not require a primary care doctor’s referral to see a specialist.
cover the costs for emergency and urgent care.

Private Fee-for-Service (PFFS) plans

share the cost of medical services with you by covering a predetermined amount so that you can pay the remaining balance for the medical service.
allow you to join Part D if it isn’t included in your chosen PFFS plan.
don’t require you to select a primary care doctor.
don’t require a primary care doctor’s referral to see a specialist.
may not cover out-of-network care and emergencies.
are unable to be combined with Original Medicare.

Special Needs Plans (SNPs)

provide coverage for people with specific diseases.
include Medicare Part D drug coverage.
may require you to select a primary care doctor.
may require a primary care doctor’s referral to see a specialist.
provide coverage to those who need nursing care at home, have chronic/disabling illnesses, or receive Medicare and Medicaid.

Medicare Medical Savings Account (MSA) Plans

may cover medical service costs once you meet your selected plan’s high deductible.
provide a choice of providers and services.
act as savings accounts for healthcare expenses.

Watch the video below to learn more about various plan options.

Medicare

Lessons