Medicare Advantage plan types: HMO, PPO, PFFS and Special Needs Plans

Medicare Advantage plans all cover what Original Medicare covers, but they work differently depending on the type. The type tells you most of what you need to know about doctors and referrals.

HMO (Health Maintenance Organization)

• You generally must use doctors and hospitals in the plan's network, except in emergencies and for urgent care while traveling.
• You usually choose a primary care doctor and need referrals to see specialists.
• Often the lowest premiums. Some HMOs have a point-of-service (HMO-POS) option that lets you go out of network for some services, at a higher cost.

PPO (Preferred Provider Organization)

• You can see doctors outside the network, but you pay more when you do.
• You usually don't need referrals for specialists.
• Premiums are often higher than HMOs in exchange for that flexibility.

PFFS (Private Fee-for-Service)

The plan sets how much it pays doctors and hospitals. You can see any provider who accepts the plan's terms, but providers can decide visit by visit whether to accept, so call ahead. Some PFFS plans have networks.

Special Needs Plans (SNPs)

Plans limited to people who fit a group, with benefits and doctors chosen for them:

• D-SNP: for people with both Medicare and Medicaid.
• C-SNP: for people with certain chronic conditions, like diabetes or heart failure.
• I-SNP: for people who live in a nursing home or need that level of care at home.

Who qualifies for each and when you can join: Special Needs Plans explained.

MSA (Medical Savings Account)

A high-deductible plan where Medicare deposits money into a savings account you use for care. MSA plans don't include drug coverage, so you'd add a separate Part D plan.

What to check in any plan

• Are your doctors, hospitals and pharmacy in the network?
• The yearly out-of-pocket maximum, and copays for the care you use most.
• Whether your prescriptions are on the plan's drug list.
• Which services need prior approval.