Types of Medicare Advantage Plans

Health Maintenance Organization (HMO) Plan

Can I get my health care from any doctor, other health care provider or hospital?

No. You generally must get your care and services from doctors, other health care providers or hospitals in the plan's network. In some HMO plans, you'll be able to go out-of-network for certain services, usually for a higher cost. This is  HMO with a point-of-service (POS) option.

Are prescription drugs covered?

In most cases, yes. If you want Medicare drug coverage, you must join an HMO Plan that offers prescription drug coverage.

Do I need to choose a primary care doctor? In most cases, Yes.

Do I have to get a referral to see a specialist? In most cases, yes. Certain services, like yearly screening mammograms, don't need a referral.

What else do I need to know about this type of plan?

• If your doctor or other health care provider leaves the plan's network, your plan will tell you. You may choose another doctor in the plan's network.
• If you get health care outside the plan's network, you may have to pay the full cost.
• If you need more information than what's listed on this page, check with the plan. 

Preferred Provider Organization (PPO) Plan

Can I get my health care from any doctor or health care provider or hospital?

Yes. PPO plans have network doctors, other health care providers and hospitals, but you can also use out-of-network providers for covered services, usually for a higher cost. You're always covered for emergency and urgent care. 

Are prescription drugs covered?

In most cases, Yes. If you want Medicare drug coverage, you must join a PPO Plan that offers prescription drug coverage.

Do I need to choose a primary care doctor? No.

Do I have to get a referral to see a specialist?  In most cases, No.

What else do I need to know about this type of plan?

• Because certain providers are "preferred", you can save money by using them.
• If you need more information than what's listed on the page, check with the plan.

Private Fee-for-Service (PFFS) Plan

Can I get my health care from any doctor?

You can go to any Medicare-approved doctor, other health care provider or hospital that accepts the plan's payment terms and agrees to treat you. If you join a PFFS Plan that has network, you can also see any of the network providers who have agreed to always treat plan members. 

Are prescription drugs covered?

Sometimes. If your PFFS Plan doesn't offer drug coverage, you can join a Medicare Prescription Drug Plan to get coverage.

Do I need to choose a primary care doctor? No.

What else do I need to know about this type of plan?

• The plan decides how much you pay for services
• Some PFFs plans to contract with a network of providers who agree to always treat you, even if you've never seen them before.
• Out-of-network doctors, hospitals and other providers may decide not to treat you, even if you've seen them before.
• For each service you get, make sure to show your plan member card before you get treated.
• In a medical emergency, doctors, hospitals and other providers must treat you.
• If you need more information than what's listed on this page, check with the plan.

Special Needs Plan (SNP)

It provides benefits and services to people with specific diseases, certain health care needs or limited incomes. It tailors their benefit, provider choices and drug formularies to best meet the specific needs of the groups they serve.

Are Prescription drugs covered? Generally, yes.

Do I need to choose a primary care doctor? In most cases, Yes. 

What else do I need to know about this type of plan?

These groups are eligible to enroll in an SNP:

• People who live in certain institutions or who need nursing care at home.
• People who are eligible for both Medicare and Medicaid
• People who have specific severe or disabling chronic conditions. Plans may have further limited membership.

An SNP provides benefits targeted to its members' special needs, including care coördination services.

If you need more information than what's listed on this page, check with the plan.

When can I join, switch or drop a Medicare Advantage Plan?

• When you first become eligible for Medicare, you can sign up during your Initial Enrollment Period.
• If you have a Part A coverage and you get Part B for the first time during  the General Enrollment Period

If you drop a Medigap policy to join a Medicare Advantage Plan, you won't be able to get it back. Rules vary by state and situation. 

Can I make changes to my coverage?

Between January 1-March 31 of each year, you can make these changes during the Medicare Advantage Open Enrollment Period:

• Switching to another Medicare Advantage Plan
• Returning to Original Medicare; Join a Medicare Prescription Drug Plan

However, during this period, you can't:

• Switch from  Original Medicare to a Medicare Advantage Plan
• Join a Medicare Prescription Drug Plan if you're in Original Medicare
• Switch from one Medicare Prescription Drug Plan to another if you're in Original Medicare.

You can only make one change during this period, and any changes you will make will be effective the first of the month after the plan gets your request.

Special Enrollment Periods

In most cases, you must stay enrolled for the calendar year starting the date your coverage begins. However, in certain situations, you'll be able to join, switch or drop a Medicare Advantage Plan during a special enrollment period when certain events happen in your life. For more information, check with your plan.

How do I switch?

1. To switch to a new Medicare Advantage Plan, simply join the plan you choose during one of the enrollment periods. 
2. To switch to Original Medicare, contact your current plan.

For more details, visit Medicare.gov/plan-compare  or call  1-800-MEDICARE.