Four Parts of Medicare

Private insurance companies who offer Medicare advantage plans usually offer many different plan options. As a consumer you are free to choose the plan you prefer, but it is important to note the differences in each plan.

Health Maintenance Organization (HMO)

Medicare Advantage HMO plans typically:

• Select a primary care physician (PCP) from within the network
• Referrals to specialists go through your PCP. However, our plans do not require this.

Preferred Provider Organization (PPO)

Medicare Advantage PPO plans typically:

• Have no network restrictions or referrals
• May have higher premiums

Office visits to your family doctor are covered at a low co-payment. We reimburse you for all medically necessary benefits. It may cost more to get care from out-of-network providers with the exception of emergency and urgent care.

Special Needs Plans (SNPS)

This type of Medicare Advantage plan that’s designed to serve people with specific health conditions.

Private Fee-for-Service (PFFS)

In this type of plan, the private insurance company determines how much it will pay and how much you must pay for care.