Medicare Advantage is not a single plan design. Different structures affect where you can receive care, how costs are paid and who can enroll. The number of choices available to you depends on your county, eligibility and plan year.
Compare the main structures
| Type | What to verify |
|---|---|
| HMO | Usually requires network providers and specialist referrals; covered emergency, urgent and out-of-area dialysis care have exceptions. |
| PPO | Generally allows covered out-of-network care at a higher cost and does not require specialist referrals. |
| SNP | Serves eligible people with specified chronic conditions, Medicaid eligibility or institutional care needs; networks and access rules still matter. |
| PFFS | Providers must accept the plan's payment terms and agree to treat you; some plans have networks. |
| MSA | Combines a high-deductible Medicare Advantage plan with a medical savings account funded by the plan. |
A PFFS plan is not Original Medicare
A provider taking Medicare does not automatically accept every Private Fee-for-Service plan. For a non-network provider, confirm acceptance of the payment terms for the visit. PFFS does not require a primary care doctor or specialist referral. If its coverage excludes Part D, you can obtain Part D through a separate plan.
Prescription coverage differs by arrangement
Most HMO and PPO Medicare plans include Part D; SNPs must include it. MSA plans do not include Part D, so a separate Part D plan is needed if you want that insurance. Do not add a separate Part D plan to an HMO or PPO without checking the rules: it can end your Medicare Advantage enrollment.
Choose by fit, not by initials
A PPO is not automatically better than an HMO, and an SNP requires more than preferring its benefits. Confirm the exact providers, medical spending limits, service costs and eligibility evidence. An MSA deposit should not be confused with complete payment of the plan deductible.
Use the current Summary of Benefits and Evidence of Coverage for the specific plan. Check enrollment dates and the effect on employer or other insurance. Availability of one structure elsewhere does not establish that it is offered where you live.
Related coverage questions
- Medicare HMO and PPO: Networks, Referrals and Costs
- Special Needs Plans: Types, Eligibility and Questions
- Medicare MSA Plans: How the Deposit and High Deductible Work