Medicare Advantage programs generally fall into a few different types. Here are the 3 most common types of Medicare Advantage programs:
Medicare Advantage HMO are private plans that the federal government pays to administer Medicare benefits. Like all Medicare Advantage Plans, Medicare Advantage HMOs must provide you with the same benefits, rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs. Some HMOs offer additional benefits, such as vision and hearing care.
Medicare Advantage PPO must provide you with the same benefits as Original Medicare but may do so with different rules, restrictions, and costs. PPOs can also offer additional benefits. PPO’s are generally more flexible than Medicare HMO plans. You are able see any doctor in the network without a referral. You can also treat outside the network, usually at a slight higher cost.
Medicare Advantage PFFS (Private-Fee-for-Service) plans is a type of Medicare Advantage plan offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medicare Supplement plans. With a PFFS plan, the plan determines how much it will pay doctors, other healthcare providers and hospitals—and how much you must pay when you get care. PFFS generally have no network or a very small network. You can see any doctor who will bill the plan as long as they agree to the plan’s terms and conditions up front.