Menu Close

Different Types of Medicare Advantage Plans

Find Medicare Advantage Plans for 2021 and click here is a good choice for many seniors, particularly those who have health issues. Plans help to provide extra coverage for seniors who need additional care.

There are other programs offered under the healthcare program, but these are generally more of a benefit than a primary source of healthcare. Medicare Advantage Plans offers more comprehensive coverage than other types of coverage, such as HMOs and PPOs. The most common plan options include:

Health Maintenance Organization (HMO) – This is a group plan that is intended to offer comprehensive medical care at a fee for service rate. Patients are required to pay a co-payment, and in return receive a specified number of doctor visits, as well as prescription drug coverage and managed care coverage. In order to get a Medicare Advantage Plan with an HMO, patients must first request the program by filling out an application for a Medicare Advantage Plan.

Preferred Provider Organization (PPO) – A PPO is a network of doctors and hospitals that the patient must choose from. The plan’s network of providers is agreed upon by the insurance company and the provider. It allows you to see a specified number of doctors within its network. Typically, the insurance company pays 100% of the cost of the doctor’s visit.

Managed Care Plan – This is an insurance plan where the physician may agree to a payment schedule based on a reimbursement schedule established by the insurance company. The physician pays a percentage of what they bill, whereas the insurance company covers the remaining portion. An example of this is the Aetna Health Maintenance Organization, which allows you to see an M.D., to receive prescriptions, and see a dentist if you so choose.

A PPO allows you to see a list of preferred physicians, as well as a hospital within its network. For this reason, it is sometimes referred to as a “preferred provider network.” You can also find plans that offer network options.

Individual PPO – This plan offers you the same coverage as a PPO, but it is an individual plan. You are not required to accept doctors in the network, as long as you have an appointment.

MCO – Often, MCOs are referred to as “managed care.” This plan is similar to a PPO, but it is an independent plan. You may choose whether or not to use your doctors in the network and only pay for your doctor visits and prescription drugs.

Pre-payment plan – A pre-payment plan is an alternative type of plan. Unlike an HMO, a PPO, or an MCO, a PPO allows you to pay for all services you receive from the insurance company. This is referred to as a PPO “no service fee.”

HMO – An HMO is a managed care network where the insurance company takes over the responsibility of determining your eligibility for medical care. In other words, it is a type of HMO where the patient chooses the doctors they want to see and their network is provided to them.

PO – A PPO offers a number of benefits that are similar to a PPO, but it also offers a “no service fee.” If you do not choose a doctor in the network, you will not be billed a single penny. Some companies also offer a no enrollment fee.

Do not forget that you are entitled to Medicare health insurance. The best way to find a qualified insurance agent or plan is to use Medicare’s online application.