Compare types of Medicare Advantage Plans

 

HMO

Health Maintenance Organization

PPO

Preferred Provider Organization

MSA

Medicare Savings Account

PFFS

Private Fee-for-Service (PFFS) Plan

SNP

Special Needs Plan

Premium
Do these plans charge a monthly premium?
Yes
Many charge a premium in addition to the monthly Part B premium.
Yes
Many charge a premium in addition to the monthly Part B premium.
No
MSA plans don’t charge a premium, but you must continue to pay your Part B premium.
Yes
These plans usually charge a premium in addition to the monthly Part B premium.
Yes
Many charge a premium in addition to the monthly Part B premium.
Drugs
Do these plans offer Medicare prescription drug coverage (Part D)?
Usually
If you join an HMO plan that doesn’t offer drug coverage, you can't get a separate Medicare drug plan.
Usually
If you join a PPO plan that doesn’t offer drug coverage, you can't get a separate Medicare drug plan.
No
If you join a separate MSA plan and want Medicare drug coverage, you’ll have to join a separate Medicare drug plan.
Sometimes
Prescription drugs may be covered. If your PFFS Plan doesn’t offer drug coverage you’ll need to join a separate Medicare drug plan (Part D) to get drug coverage.
Yes
All SNPs must provide Medicare prescription drug coverage (Part D).
Providers
Can I use any doctor or hospital that accepts Medicare for covered services?
Sometimes
You generally must get your care and services from doctors, other health care providers, or hospitals in the plan’s network (except emergency or urgent care or out-of-area dialysis). In an HMO Point-of-Service (HMOPOS) Plan you may be able to get some services out of network for a higher copayment or coinsurance.
Yes
Each plan has a network of doctors, hospitals, and other health care providers that you may go to. You may also go out of the plan’s network, but your costs may be higher.
Yes
MSA plans generally don’t have network providers. You can get covered services from any Medicare provider in the U.S. or U.S. territories.
Yes
You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan’s payment terms and agrees to treat you.  If the plan has a network, you can use any of the network providers, but if you go to an out-of-network provider that accepts the plan’s terms, you may pay more.

Varies by plan
Some SNPs require that you get your care and services from providers and facilities in the plan’s network (except for emergency care, out-of-area urgent care, or out-of-area dialysis).  

However, some SNPs do offer out-of-network coverage, so you can get services from any qualified provider or facility, but you’ll usually pay more. 

Primary Care
Do I need to choose a primary care doctor?
UsuallyNoNoNoVaries by plan
Some SNPs require you to choose a primary care doctor and others don’t.  
Referrals
Do I have to get a referral to see a specialist?
YesNoNoNoVaries by plan
Some SNPs require referrals and others don’t. Referrals may be required for certain services but not others.

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