HMO: Health Maintenance Organization Plan
• This is a network-based medicare advantage plan. This means you will have a limited selection of providers within that network.
• Prescription drug coverage is included in most cases, but make sure when you sign up.
• You will most likely need to choose a primary care doctor with this type of plan.
• If your health care provider leaves your network, you will be notified and have an opportunity to pick a new primary care physician.
• It’s important to follow the plans rules, some services may need prior approval.
• Be sure to check with your plan about any other rules or conditions that may apply to you.
PPO: Preferred Provider Organization Plan
• PPO plans have networks like HMO’s, but they are usually a bit more flexible.
• Prescription drug coverage is usually provided. Be sure to check with your PPO provider to be sure.
• You will generally not need to choose a primary care doctor.
• In most cases you will not need a referral to see a network specialist.
• These plans generally offer more coverage than available through Original Medicare but are also generally more expensive.
PFFS: Private Fee-For-Service Plan
• With this type of plan, you can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plans payment terms and agrees to treat you.
• Some PFFS Plans have networks, others do not. Costs will vary between in network and out of network providers with these kinds of plans.
• Some in network providers will always treat you even if you’ve never been treated there before due to network agreements.
• Some out of network providers may decide not to treat you even if they’ve treated you before.
• You will not need to choose a primary care doctor.
• You will not need to get a referral to see a network specialist.
• These aren’t the same as Original Medicare or Medigap coverage.
• The plan decides how much you pay for services.
• For each service you get, make sure to show your plan member card before treatment.
• In a medical emergency doctors, hospitals, and other providers must treat you.
SNP: Special Needs Plan
• These types of plans limit themselves to these specific groups:
• People who live in certain institutions, like nursing homes, or who require nursing care at home OR
• People who are eligible for both Medicare & Medicaid OR
• People who have specific chronic or disabling conditions (such as HIV, or end stage renal disease.)
• Plans may limit membership further if they choose
• Your plan will coordinate the services and providers you need to help you stay healthy and follow doctors’ or other health care providers’ orders.
• Generally, these plans do have networks that you MUST stay within, unless you have a medical emergency.
• All SNP plans must provide Medicare prescription drug coverage.
• You will need to choose a primary care doctor in most cases.
• In most cases you will need a referral to see a network specialist.