What are the types of Medicare Advantage plans?
Answered by 8 licensed agents
Answered by Ben Washington on June 30, 2025
Broker Licensed in IL, FL, MN, SC, TX & WI
Answered by Edward Smith, ChFC, CRPS, AIF on June 30, 2025
Broker Licensed in OH, GA, IN, KY & SC
Answered by Holt Rushing on June 30, 2025
Broker Licensed in MS, AK, AL & 29 other states
MAPD - Medicare Advantage Plan with Drug Coverage
MA - Medicare Advantage Plan without drug coverage
HMO - In-network only plans
PPO - In-network and out-of-network plans
PFFS - Private Fee For Service (not very common)
Answered by Justin Call on June 30, 2025
Broker Licensed in UT, ID, MT & WY
Answered by Jane Ahrens on June 30, 2025
Broker Licensed in NY, AL, AZ & 16 other states
Here's a breakdown of the different types:
Health Maintenance Organization (HMO) Plans:
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These plans require you to choose a primary care physician (PCP) who coordinates your care. You'll generally need referrals to see specialists, and you'll typically need to stay within the plan's network of providers to have your care covered.
Preferred Provider Organization (PPO) Plans:
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PPO plans offer more flexibility than HMOs, allowing you to see specialists and out-of-network providers, though you'll usually pay more for doing so.
Private Fee-for-Service (PFFS) Plans:
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PFFS plans allow you to see any doctor who accepts the plan's payment terms. However, not all doctors may accept these terms, so it's crucial to check with your providers.
Special Needs Plans (SNPs):
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SNPs are designed for specific groups of people, such as those with certain chronic diseases, those who live in institutions, or those who are dually eligible for both Medicare and Medicaid.
Medicare Advantage plans often include additional benefits not offered by Original Medicare, such as prescription drug coverage, dental, vision, and hearing coverage. They also may have lower out-of-pocket costs for certain services compared to Original Medicare.
Answered by Fred Manas on June 30, 2025
Agent Licensed in NY, CT, DC & 7 other states
Answered by Vachik Chakhbazian on June 30, 2025
Agent Licensed in CA, AL, AR & 22 other states
First, there are dual plans and non-dual plans, meaning those that also require a certain level of Medicaid and those that are available without.
Second, there are chronic condition advantage plans which require certain diagnoses to enroll in them (for example, diabetes or COPD).
There area also MA only advantage plans, which mean they do not including Rx or PDP (prescription drug coverage).
Finally, there a categories of advantage plans based on what kind of network they adhere to (for example, HMO- must use the network unless an emergency, PPO- you pay the lowest cost in network but you can go anywhere so long as the provider accepts it, PFFS- private fee for service, also network based but flexible, POS- point of sale, allow for some out of network coverage.
Some of these can be combined (for example, you could have an MA only PPO or a dual PPO (also known as DSNP). The dual plans and chronic plans are also known as SNPs or Special Needs Plans.
Great questions because knowing how your plan may limit your access or enable flexibility is important to know, especially in an environment where we are seeing a bit of tightening in the network acceptance of the most restrictive plans (HMOs).
I hope this response is useful to your and others. Good luck in your Medicare years!
Answered by David Treadway on June 30, 2025
Agent Licensed in OH, IN, KY & MI, SC, TN & VA
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