Medicare Health Plans

A Medicare health plan is a plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan.  There are several different types of Medicare Health Plans, including the following:

  • Medicare Advantage Plans—Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for -Service Plans (PFFS), Special Needs Plans (SNP) and Medicare Medical Savings Plans.

Medicare Advantage Plans (also known as Part C or MA Plans), are offered by private companies approved by Medicare.  If you join a Medicare Advantage Plan, you still have Medicare.  You’ll get your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage from the Medicare Advantage plan you choose.

The way these plans work is that Medicare pays a fixed amount for your care each month to the private companies offering the Medicare Advantage (MA) Plan.  These companies must follow rules set by Medicare.  However, each insurance company offering the MA plan can charge different out-of-pocket costs and have different rules for how you get services, for example, referrals and specific networks may be required, all depending on the plan you chose.  We will review all of that with you to help you select the plan that is best for you.

Examples of out of pocket costs include possible monthly premiums, annual deductible, and co-pays and/or coinsurance.

There are different types of Medicare Advantage Plans.  They include:

Health Maintenance Organizations (HMO) plans—In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plans network except in an emergency.  You may also need to get a referral from your primary care director.

Preferred Provider Organization (PPO) plans—In a PPO, you pay less if you use doctors, hospitals and other health care providers that belong to the plan’s network.  There is usually an out of network benefits, but that is after a deductible and coinsurance.

Private Fee-for Service (PFFS) plans—PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they agree to treat you. The plan determines how much it will pay these facilities, and how much you must pay when you get care.

Special Needs Plans (SNPs)—SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.

HMO Point-of-Service (HMOPOS) plans—These are HMO plans that may allow you to get some services out-of-network without a referral, although there may be a higher copayment or coinsurance.

Medical Savings Account (MSA) plans—This is a plan that combines a high-deductible health plan with a bank account. Medicare deposits money into the account. You can use the money to pay for your health care services during the year.