Medicare Advantage Types

Health Maintenance Organization (HMO)

  • Choose a doctor (primary care physician) from a list of contracted / network physicians

  • Care is coordinated through your primary care physician's office with referrals to specialists

  • Most referrals are handled electronically to ease the process

  • Some plans may not require referrals for certain services

  • No out-of-network coverage except emergency, urgently needed services, and dialysis when traveling outside your plan's service area

Preferred Provider Organization (PPO)

  • Select physicians of your choice; out-of-pocket costs are generally less if using plan's available network

  • No referrals to see a specialist

  • Out-of-network coverage

  • More flexibility, but may have higher out-of-pocket costs

Special Needs Plans

  • Medicare SNPs are a type of Medicare Advantage Plan

  • Limits membership to those with specific diseases or characteristics

  • Chronic conditions (C-SNP)

  • Dual-eligible (D-SNP) (medicaid/medicare)

  • Institutional (I-SNP)

  • Benefits, provider choices, and drug formularies designed to best meet specific needs of the groups they serve

Medicare Supplements

Medigap is a Medicare Supplement Insurance that helps fill ‘gaps’ in Original Medicare that is sold by private companies. The plan helps pay some of the remaining health care costs that Original Medicare does not cover, such as:

  • Copayments

  • Coinsurance

  • Deductible

Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here's what happens:

  • Medicare will pay its share of the Medicare-Approved Amount for covered health care costs.

  • Then, your Medigap insurance company pays its share.

Health Insurance Types

  • ACA known as affordable care act plans or ACA compliant plans where some families and individuals may qualify for subsides.

  • ACA plans complaint plans for individuals with pre-existing conditions

  • Group insurance plans for employer sponsored health insurance

  • Short term medical plans

  • Underwritten insurance plans for healthy individuals that provide your standard benefits of care but may exclude mental health and maternity coverage