Medicare Advantage Programs

Medicare Advantage programs generally fall into a few different types. 

Here are the three most common types of Medicare Advantage programs:

Medicare Advantage Networks

Types of Medicare Advantage Programs

Medicare Health Maintenance Organizations (HMO) plans usually require a referral from a doctor before you can go to a specialist within your network. You choose a primary care doctor that is in your plan’s network. These plans tend to have the lowest monthly premium of the different types because they generally can be the most restrictive.

Medicare Preferred Provider Organization (PPO) plans are more flexible than HMO plans. Members can generally see doctors inside their network without a referral and receive treatment outside of your network, but it will cost more to do so.

PFFS or Private Fee For Service plans do not have a network or have a small network. You can see any doctor that will bill the plan as long as they accept your plan and its terms. This puts the responsibility on you to ask your providers if they accept the plan before you can use their service.

Other Medicare Advantage Plan Types

Special Needs Plans or SNPs are available only to Medicare recipients with specific health conditions or circumstances, for instance, being eligible for Medicaid and Medicare. This plan was created to address those particular health needs with a special provider. A majority of SNP plans are in the form of an HMO.

Medical Saving Account Plans or MSAs offer you a health savings account along with insurance benefits. Medicare will put a set amount into your account every year. You can spend this whenever you use any qualifying health service.

Medicare Advantage Enrollment

You can pick up a Medicare Advantage plan during your seven-month Initial Enrollment Period. You can join or leave Medicare Advantage during the Open Enrollment Period (sometimes referred to as Annual Enrollment Period (AEP), which begins October 15th and ends December 7th.

Multiple Special Enrollment Periods exist, and if you qualify, you may be able to join mid-year. One of the common ones is when you move to a different state and lose your existing Medicare Advantage plan. Medicare will allow you a 63 day period to choose another plan in your new state. Another Special Enrollment Period can occur if you become eligible for Medicaid or the Part D Extra Help program. 

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