If you are shopping for Medicare Advantage plans, you may have noticed that there are several different types of plans on the market. One common type of Advantage plan is the Health Maintenance Organization (HMO) style of policy, another is the Preferred Provider Organization (PPO) type. If you are considering one of these policy types, here is some information you may need to make an informed decision.
Different Types Of Medicare Advantage Plans
There are several different types of Medicare Advantage plans. Each one provides the same core benefits, but each one has a unique structure that has specific advantages and disadvantages. The cost of each policy varies as well and so do the rules. As some policy types may limit the providers you can see to a specific network, while others don’t.
These are the Medicare Advantage plan types:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-service (PFFS)
- Special Needs Plans (SNPs)
What Is A Health Maintenance Organization Plan?
With an HMO plan, you typically must receive care and services from providers who are within your plan’s network. The exception to this rule applies in cases of emergency or urgent care and when receiving out-of-area dialysis treatment. Most Medicare Advantage HMO plans include prescription drug coverage as well, but verify that this coverage is included with your preferred provider.
With an HMO plan, you will need a referral from a primary care physician to see specialists as well. Although, some services, like yearly screening mammograms, won’t require a referral. If you choose to seek care outside of your HMO plan’s network, you may be required to pay the full cost out-of-pocket. Before receiving treatment, verify that the health care provider is covered within your network.
What Is A Preferred Provider Organization Plan?
PPO plans are similar to HMO plans, but they are slightly more flexible. With a PPO plan, you are not expressly required to receive treatment from in-network providers. Though, if you choose to receive treatment from out-of-network providers, your plan may cover less of the costs.
With a PPO plan, you don’t need a primary care doctor or referrals to see specialists either. This introduces additional flexibility that expands your access to the health care providers you want to work with. You can easily find PPO plans that include prescription drug coverage too. With the right PPO plan, you will have very versatile long-term health care coverage.
Which Medicare Plan Is Better, HMO or PPO?
Which Medicare plan is best for you depends on your health care needs. While some people like having access to out-of-network providers, others don’t need this benefit. Discussing your options with a qualified Medicare professional will help you determine which option fits you best. Reach out to the specialists at The Fussell Group Insurance Advisors now to get started.