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What are the Different Kinds of Medicare Advantage Plans?

Updated: Jan 20, 2021

Medicare Advantage plans are private health insurance plans offered to seniors who qualify for Medicare. These plans cover Parts A and B of Medicare insurance and typically also include prescription drug coverage and other services such as hearing and dental that Original Medicare does not cover. Medicare Advantage plans are also sometimes called “Part C” or “MA Plans.”

What are the different kinds of Medicare Advantage plans?

  • Health Maintenance Organization (HMO) Plans

  • Preferred Provider Organization (PPO) Plans

  • Private Fee-for-Service (PFFS) Plans

  • Special Needs Plans (SNPs)

There are also other less common types of Medicare Advantage Plans that may be available, including HMO Point of Service (HMOPOS) Plans and a Medicare Medical Savings Account (MSA) Plan.

Health Maintenance Organization (HMO) Plans: In most HMO Plans, recipients must choose a primary care doctor and receive care and services from providers in the plan's network. Prescription drugs are usually covered in HMO Plans.

HMO Point of Service (HMOPOS) Plans: HMOPOS allow their members to use healthcare providers that are outside the plan's network for some or all services. (POS stands for Point of Service).

Preferred Provider Organization (PPO) Plans: PPO Plan enrollees are not usually required to choose a primary care physician but they are expected to use their plan’s in-network doctors, health care providers, and hospitals to pay the lowest rates for services. Out-of-network service providers are an option but cost more. Prescription drugs are usually covered in PPO Plans.

Private Fee-for-Service (PFFS) Plans: In a PFFS Plan, enrollees can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan's payment terms and agrees to provide healthcare services. Some PFFS Plans include prescription drug coverage. Many seniors who opt for a PFFS Plan add on Medicare Part D to get prescription drug benefits.

Special Needs Plans (SNPs): Medicare SNPs are only available to seniors with specific diseases or characteristics. Each Medicare SNP is customized to meet the specific needs of the group they are serving including the benefits, provider choices, and drug formularies they include. All SNPs are required to provide Medicare prescription drug coverage.

Medicare Medical Savings Account (MSA) Plan: an MSA Plan combines a high-deductible insurance plan with a medical savings account that subscribers can use to pay their health care costs before their deductible is met.

When can I sign up for a Medicare Advantage Plan?

You can sign up or switch to a new Medicare Advantage plan right now! Annual Enrollment period began on October 15, 2020 and runs through December 7, 2020.

How can I sign up for a Medicare Advantage Plan?

MA plans are offered by Medicare-approved private companies that must follow rules set by Medicare. With so many types of Medicare Advantage Plans available, we recommend reaching out to a local, reputable Medicare agency who can walk you through your options. The best part is that Medicare agencies offer their services at no charge to seniors. A great Medicare agent will show you the best options for your needs, help you sign up and be there to help you with coverage questions and any issues that come up.

Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.

At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.


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