Be sure you understand the different types of Medicare Advantage plans before you enroll
There are several different types of Advantage plans available. Some are distinguished by the type of network and others by who may be eligible for their specific benefits.
Watch the following video about different plan types so you understand how a plan will effect the delivery of benefits.
A word about Medicare Advantage plan availability and similarities
Medicare Advantage plans are available County by County. The type and number of plans you have available may be considerably different than what is available in a neighboring County.
Expect to have less choice if you live in a sparsely populated rural County. Companies that market Medicare Advantage plans can choose where they make their plans available and choosing Counties where they will have greater success is in their best interests.
It’s also quite possible that the same named plan will include different benefits and monthly premium from County to County.
One thing you can be assured of when choosing a Medicare Advantage plan is that they will all include Part A and Part B benefits.
The vast majority of plans also include Part D drug coverage.
- MAPD = Medical + drug coverage
- MA = Medical only
Another thing different types of plans will have in common includes the likelihood that you will pay deductibles, copayments and coinsurance when you receive services.
Medicare Advantage plans also include monthly premiums, some as low as $0 per month ( It’s against the rules to call them free).
Types of Medicare Advantage plans
Network differences will have an impact on how you use your plan and where you can receive services. Types of networks include:
A PPO gives you access to a group of preferred providers where you will have less out-of-pocket in the form of cost sharing for services than if you receive those same services out of network.
The main point to take away from a PPO is that you do have the freedom to receive services out of network.
A HMO network is a Health Maintenance Organization where you are required to receive your services only from network providers. You will generally need a referral from your primary doctor to see a specialist.
Receiving services out of network is generally not an option so be certain you are comfortable with the provider network before you join.
A HMO-POS is a HMO with a point of service option. It has features similar to both a HMO and PPO. You are afforded little more freedom to receive services out of network.
A Private Fee-For-Service (PFFS) is another type of plan where you are free to choose your own provider as long as that provider will accept the plan’s payment terms and conditions. The provider can choose to accept a PFFS plan on a visit by visit basis.
Special Needs Medicare Advantage plans – not for everyone
Another type of Medicare Advantage plan is the Special Needs Plan. There are three type of Special Needs Plans. These plans require that you must meet certain criteria in order to join. These criteria include:
- That you have a specified chronic illness
- That you are dual-eligible (have both Medicare & Medicaid)
- That you live in an institution such as a nursing home
Special Needs Plans often offer a level of coordinated care beyond what a typical plan will offer in order to meet the special needs of the member.
If you qualify for a Special Needs Plan you would generally be wise to give it consideration.
When comparing the different types of network-based plans you should certainly spend some time with the provider directory, but you should also think about the possibility of an acute illness that would be better served by a specialist outside the network. Your freedom to choose or the lack there of may come at a cost.