When choosing a Medicare Advantage plan, it's important to understand the differences between the types of plans available. Each plan has its own rules about network restrictions, costs, and care coordination.
Health Maintenance Organizations (HMOs) provide lower-cost, coordinated care but require you to stay within their network. Preferred Provider Organizations (PPOs) give you more flexibility to see out-of-network providers, though at a higher cost. Private Fee-for-Service (PFFS) plans offer the most provider choice, while Special Needs Plans (SNPs) are tailored for specific health conditions. Medicare Savings Accounts (MSAs) are great for those comfortable managing health expenses. Understanding these options can help you choose the best plan for your needs and preferences.
Click here to download a printable comparison chart.
Compare Medicare Advantage Plans
HMO (Health Maintenance Organization)
- Network Restrictions: Must use network providers
- Primary Care Physician Required: Yes
- Referrals Needed for Specialists: Yes
- Out-of-Network Coverage: Emergency only
- Prescription Drug Coverage: Usually included
- Additional Benefits: Often included
- Best For: Those who prefer coordinated care
- Typical Costs: Lower premiums, fixed copays
- Out-of-Pocket Maximum: Yes
PPO (Preferred Provider Organization)
- Network Restrictions: Can use out-of-network providers at higher cost
- Primary Care Physician Required: No
- Referrals Needed for Specialists: Usually no
- Out-of-Network Coverage: Yes, at higher cost
- Prescription Drug Coverage: Usually included
- Additional Benefits: Often included
- Best For: Those who want more provider flexibility
- Typical Costs: Higher premiums, more flexibility
- Out-of-Pocket Maximum: Yes
PFFS (Private Fee-for-Service)
- Network Restrictions: Can see any Medicare-approved provider
- Primary Care Physician Required: No
- Referrals Needed for Specialists: No
- Out-of-Network Coverage: Yes
- Prescription Drug Coverage: May be included
- Additional Benefits: May be included
- Best For: Those who want provider choice without network restrictions
- Typical Costs: Varies
- Out-of-Pocket Maximum: Yes
SNP (Special Needs Plan)
- Network Restrictions: Typically network-based
- Primary Care Physician Required: Usually
- Referrals Needed for Specialists: Often
- Out-of-Network Coverage: Varies
- Prescription Drug Coverage: Always included
- Additional Benefits: Often included
- Best For: Those with specific health conditions or circumstances
- Typical Costs: Varies based on specific needs
- Out-of-Pocket Maximum: Yes
MSA (Medicare Savings Accounts)
- Network Restrictions: No network restrictions
- Primary Care Physician Required: No
- Referrals Needed for Specialists: No
- Out-of-Network Coverage: Yes
- Prescription Drug Coverage: Not included
- Additional Benefits: Not typically included
- Best For: Those who prefer lower premiums and can manage health savings
- Typical Costs: High deductible, $0 premium
- Out-of-Pocket Maximum: Varies