Types of Medicare Advantage Plans

If you’re shopping for Medicare Advantage, it’s helpful to understand the different types of Medicare Advantage plans and how they work. There are three types of Medicare Advantage programs: HMO’s, PPO’s, and Fee for service plans.

Each program has its pros and cons and fit different life circumstances. Below we take a closer look at these Medicare Advantage programs to help you find your best policy.  

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About Medicare Advantage  

Medicare Advantage, also known as Medicare Part C, are private insurance policies that expand your Original Medicare benefits to include vision, dental, and prescription drug coverage. These plans also fill in the financial gaps of Original Medicare that come in the form of co-pays, coinsurance, and multiple deductibles. Medicare Advantage protects both your health and your bank account. 

Types of Medicare Advantage Plans

Here are the three main types of Medicare Advantage programs: 

Medicare Advantage HMO

HMO plans (health maintenance organization) use a local network of care providers to facilitate all the benefits and covered services of your policy.

Upon enrollment, you choose an in-network primary care physician to be the main point of reference for all your care services.

Your designated primary care physician issues all referrals for testing, specialist care, and other needed health care services. Your designated physician is the person who directs and determines the care services that you need. 

This process reduces the overall health care cost of the network by eliminating unnecessary office visits and needless care services. 

A Medicare Advantage HMO plan offers you lower premium rates in exchange for going through a primary care physician to schedule your medical care. HMO plans are usually the lowest cost Medicare Advantage program.  

For some, this process may seem like a hassle. However, many people prefer to go through these steps for a lower monthly premium.

HMO plans are a good fit for people who anticipate general care and routine medical services in the upcoming year. However, if your health situation requires frequent specialized care, then obtaining referrals may become a hassle, and you may want to consider a different Medicare Advantage program. 

Medicare Advantage PPO 

Medicare PPO plans (preferred provider organization) are more popular than HMO plans because it gives you the freedom to schedule all your care services without needing a doctors referral.

As with HMO’s, a Medicare Advantage PPO plan uses a local network of care providers to administer all the benefits covered in your policy. However, PPO plans allow you to schedule and see doctors outside of your local network as long as they take Medicare patients. This type of Medicare Advantage program offers lower costs if you see an in-network ‘preferred’ provider.  

Medicare PPO’s typically have a higher annual deductible and higher monthly premiums. However, individuals suffering from poor health will find this type of Medicare advantage plan attractive due to the convenience of not needing a referral when receiving regular medical care. 

Medicare Advantage FFS

Medicare FFS plans (Fee For Services) require you to pay a fee every time you need to access the benefits inside your policy. Your policy sets the required fees for all Medicare-covered services. This Medicare Advantage type is not near as popular as the other two mentioned above. However, FFS plans will fit well with individuals who are in good health and do not foresee using their Medicare benefits much in the upcoming year. 

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Which Type Of Medicare Advantage Program Is Right For You?

Determining the best Medicare Advantage program for you depends on your health status, your state of residence, and your budget. As mentioned above, each Medicare Advantage program caters to different groups of individuals.  

Our independent insurance agency is here to help. Our Medicare experts take the time to understand your unique life circumstances to help you navigate and find your best Medicare Advantage policy. We also can help you explore Medicare Supplemental Insurance as an alternative way of covering the financial gaps within Medicare. 

Our independent agents work for YOU, not the insurance companies.  

We’ve helped thousands of Medicare beneficiaries protect their health and their bank account with Medicare Advantage. We’d love to help you too!

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