While Medicare Advantage has several plan options, most beneficiaries enroll in a health maintenance organization (HMO), preferred provider organization (PPO), or a private fee-for-service (PFFS) plan. For others, these less popular types of Medicare Advantage may offer excellent benefits.
Medical Savings Account (MSA) Plans
A Medical Savings Account (MSA) plan blends traditional health insurance with the ability to save for medical expenses. You will enroll in a high-deductible health plan that will only cover your medical costs once you reach your deductible. However, your plan also connects to a special bank account that you can use to save for medical expenses—including those you incur before hitting your deductible. You cannot deposit your own money into this account. Instead, Medicare deposits a set amount each year.
These plans cover all of the services other Medicare plans cover. They may also cover dental, vision, and some long-term care.They do not cover prescription drugs. You must enroll in Medicare Part D for prescription drug coverage.
Special Needs Plans
Medicare Advantage Special Needs Plans (SNP) cater to special populations, such as people living in institutional settings and those with certain chronic illnesses. You may be eligible for a special needs plan if you meet one or more of the following criteria:
- You live in an institutional setting, such as a nursing home or long-term care facility.
- You have an eligible chronic or progressive condition, such as diabetes, HIV/AIDS, chronic lung disorders, or end-stage renal disease.
With a Special Needs Plan, you must generally seek care from the plan's network of providers, unless you have a medical emergency or need urgent care outside of the network's service area. In most cases, you must select a primary care provider who refers you to specialist services. Special needs plans offer specialists with expertise in the specific conditions their members have. They are also required to offer prescription drug coverage.
Health Maintenance Organization Point of Service Plans (HMOPOS)
A traditional health maintenance organization (HMO) covers care only when you seek it from an in-network provider. With a health maintenance organization point of service (HMOPOS) plan, you can get some services out-of-network. You will have to pay more for these services. However, this type of plan can be a good fit for someone who prefers to seek care from specific providers. For example, if you love your gastroenterologist but they are not in-network, you may still be able to see them for a higher price. You would then seek care with in-network providers for other services.
With this type of plan, the POS portion of the plan has a separate deductible from the HMO portion. So you may also have to hit a higher deductible before full coverage kicks in for out-of-network providers.
Most, but not all, HMOPOS plans cover prescription drugs.