Compare types of Medicare Advantage plans: Which one is right for you?

There are many types of Medicare Advantage plans. These include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Special Needs Plans (SNP). Every plan has different rules about which doctors you can use and what costs you pay. The right plan for you will not only meet your health needs, but fit your budget. Not all plans work for everyone. That’s why it is important to know the differences between plan types and their coverage when you are choosing a plan.

Medicare Advantage plans explained

What types of Medicare Advantage plans are available?

1. Health Maintenance Organization (HMO) Plans: 

• Use a network of participating doctors and hospitals for your care and coverage.
• May require referrals to see specialists.
• May include prescription drug coverage.

2. Preferred Provider Organization (PPO) plans:

• Offer coverage for services received both in and out of the plan’s provider network.
• Do not usually require referrals to see specialists.
• May include prescription drug coverage.

3. Private Fee-for-Service (PFFS) plans:

• Allow you to see any Medicare participating doctor or hospital that accepts the plan’s payment terms.
• May or may not include a network of providers.
• Can include prescription drug coverage, but not always. 

4. Special Needs Plans (SNP):

• Are designed for people with specific diseases or chronic illnesses, nursing care facility needs, or dual eligibility for Medicare and Medicaid. 
• Must provide prescription drug coverage.
• Often have a network of providers that specialize in the member’s specific condition. 

5. Medical Savings Account (MSA) Plans:

• Combine a high-deductible plan with a medical savings account that Medicare deposits money into.
• Allow you to use the money in the account to pay for health care costs before your deductible is met.
• Do not include prescription drug coverage, so you would need a separate Part D plan.

Compare Medicare Advantage plans side by side

How can I compare Medicare Advantage plans?

When looking for Medicare Advantage plans, it is important to consider several factors. These are key in finding the best plan for your needs and budget. 

1. Network of doctors and hospitals: Many plans offer cost savings by requiring you to get your medical care from a set network of providers. Make sure the plan has access to your preferred doctors and hospitals. Find out if the plan network includes care from the most trusted doctors and hospitals in your community.
2. Prescription drug coverage: Plans with Part D coverage have low costs for prescription drugs and access to chain and independent pharmacies as well as mail-order and prescription delivery services. Check the plan’s formulary (drug list) to make sure your prescriptions are covered.
3.  Extra benefits: A Medicare Advantage plan offers Part A, Part B, and sometimes Part D in one plan plus important extra benefits like vision, dental, hearing, fitness, and an allowance for health care products. With a Medicare Advantage plan, you pay one premium with all your coverage under one plan and have only one card to carry. However, you will still have to pay your Part B premium to Medicare. 
4. Costs: Research plans that give you coverage at a price you can afford. While some options may have lower costs for hospital stays or specialist visits, they may come with a higher monthly premium. Determine what your actual health needs are and find the plan that is right for you and your budget.
5. Plan quality ratings: Look at the plan’s quality ratings from Medicare. Higher ratings usually mean better service and customer satisfaction, which helps you choose a reliable plan.