1 Freed M. et al. (Nov. 15, 2023). Medicare Advantage 2024 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/issue-brief/medicare-advantage-2024-spotlight-first-look.
Part C
What Are the Different Types of Medicare Advantage Plans?
- January 12, 2024
- Reviewed by John Krahnert
Types of Medicare Advantage (Part C) plans can include health maintenance organizations (HMO), preferred provider networks (PPO) and other types of plans. The types of plans available where you live may vary, so be sure to compare your local plan options to learn about the types of plans available.
There are a total of 3,959 different 2024 Medicare Advantage plans available in the United States, according to the Kaiser Family Foundation (KFF).1
Plan options vary around the country, so where you live could affect your plan options.
In this guide, we detail some of the types of Medicare Advantage plans. The network restrictions, referral requirements and other plan details can vary for different types of plans.
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Health Maintenance Organization (HMO) plans
HMO plans offer low-cost coverage options with network restrictions.
If you have an HMO, you typically must seek covered medical treatment from medical providers and hospitals within your HMO plan’s specific network, unless it’s emergency or urgent care. If you go out of your network for covered care, your insurer might not pay for it, and you may be responsible for all out-of-pocket costs.
HMO plans can require you to pick a primary care physician and can require you to obtain a referral from your doctor to see a specialist, though details can vary. A licensed insurance agent can help you compare networks for plans in your area, including whether a plan is accepted by your preferred providers.
Preferred Provider Organization (PPO) plans
PPO plans offer coverage through a network of providers, but you are allowed to access out-of-network care for covered services, but usually for a higher cost. If you go to doctors and hospitals in the plan's network for covered care, you will generally pay lower out-of-pocket costs than you would if you went outside of the plan network.
You might not need to choose a primary care doctor with a PPO, and you might not be required to get a referral to see a specialist. Consult with your plan provider, however, as plan details vary. Also consult with your health care provider about whether your plan covers services before receiving them.
Private Fee-for-Service (PFFS) plans
You might consider signing up for a Medicare PFFS plan if any are available where you live and if you are interested in having greater flexibility in where you receive covered health care services.
With PFFS plans, you may go to any Medicare-approved doctor or health care facility that has accepted the plan's payment terms and agreed to treat members of your Medicare Advantage plan.
Some PFFS plans may use a provider network. If you enroll in one of these plans, you can also see any of the network providers for covered care who’ve agreed to always treat plan members. If you visit an out-of-network provider for covered care who accepts the plan’s terms, you may face higher out-of-pocket costs.
You do not typically need to choose a primary care doctor with PFFS plans, and you do not typically need a referral to see a specialist.
Special Needs Plans (SNPs)
SNPs are available to Medicare beneficiaries with specific situations or health conditions and beneficiaries who are eligible for Medicare and Medicaid. The plans are structured to benefit their members according to their health needs.
Some types of SNPs limit membership to those with chronic or disabling conditions like dementia and HIV/AIDS or those living in institutions such as nursing homes. The plans are tailored for these members to provide the most suitable benefits, providers, and drug formularies for the group.
Dual-Eligible Special Needs Plans (D-SNP) are designed for dual-eligible beneficiaries who receive Medicare and full Medicaid benefits.
Medicare Advantage SNPs usually require that you have a primary care doctor or a care coordinator. In addition, you will usually need a referral to see a specialist.
All SNPs must provide prescription drug coverage.
To learn more about Medicare Advantage plans and to find the types of plans in your area, call a licensed insurance agent today or compare plans online.
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
