Compare types of Medicare Advantage Plans
Get specific cost information about a plan type you’re interested in.
| Plan Type | Health Maintenance Organization | Preferred Provider Organization | Private Fee-for-Service (PFFS) Plan | Special Needs Plan | Medical Savings Account |
|---|---|---|---|---|---|
| Premium Do most 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. | 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 No separate monthly premium, but you must continue to pay your monthly Part B premium. |
| Drugs Does the plan offer Medicare prescription drug coverage (Part D)? | Usually If you want drug coverage, you have to join an HMO that offers it. You can't get a separate Medicare drug plan. | Usually If you want drug coverage, you have to join a PPO that offers it. You can't get a separate Medicare drug plan. | Sometimes Drugs may be covered. If you join a PFFS Plan that doesn’t offer drug coverage, you can get a separate Medicare drug plan. | Yes All SNPs must offer Medicare drug coverage (Part D). | No If you join a MSA Plan and want Medicare drug coverage, you'll have to join a separate Medicare drug plan. |
| Primary Care Do I need to choose a primary care doctor? | Usually | No | No | Sometimes Some SNPs require you to choose a primary care doctor and others don’t. | No |
| Providers Can I use any doctor or hospital that accepts Medicare for covered services? | Sometimes You generally must get your care and services from providers and facilities 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, but you usually pay more. | Yes Each plan has a network of doctors, hospitals, and other providers that you may go to. You may also go out of the plan’s provider network, but you may pay more. | Yes You can go to any Medicare-approved provider or facility that accepts the plan’s payment terms and agrees to treat you. If the plan has a network, you can use any providers in the network. If you go to an out-of-network provider that accepts the plan’s terms, you may pay more. | Sometimes If your SNP is an HMO, you generally must get your care and services from doctors or hospitals in the SNP's network (except for emergency, urgent care, or out-of-area dialysis). However, if your SNP is a PPO, you can get Medicare-covered services out of network. | Yes MSA Plans generally don’t have network providers. You can go to any Medicare-approved provider or facility that agrees to treat you and hasn't opted out of Medicare for services that Original Medicare covers. |
| Referrals Do I need a referral from my doctor to use a specialist? | Yes | No | No | Sometimes If the SNPs is an HMO, you generally need a referral. If the SNP is a PPO, you don't need a referral. | No |
Note: If you have a Medicare Advantage Plan, you’ll typically need prior authorization from your plan before it covers certain services or supplies. Contact the plan if you have questions about coverage.