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Types of Medicare Advantage Plans and the Best Providers

Medicare Advantage, also known as Medicare Part C, is a popular health insurance policy. It covers everything offered in Parts A and B (Original Medicare) and has several additional benefits. However, unlike Original Medicare, it is exclusively provided by approved private insurance companies. Some Medicare Advantage plans also cover Part D expenses, including coverage for prescription treatments. Here, we compare the types of Medicare Advantage plans and their best providers.

Types of Medicare Advantage plans
There are four types: HMO, PPO, PFFS, and SNP. Here is a quick summary of each:

Health Maintenance Organization (HMO)
It covers health expenses only if you are treated by doctors, healthcare providers, or hospitals within the plan’s network. So, if you are traveling and visit a doctor or service provider out of your defined network area, you will not get the benefits and will have to pay for the expenses from your pocket. However, emergency services may be availed at any hospital, even those outside the plan’s network. HMO plans are usually more budget-friendly and have a lower out-of-pocket cost.

Preferred Provider Organization (PPO)
Like HMOs, PPO plans have a network of healthcare providers. However, you can choose to visit out-of-network services and still get coverage. But the coverage amount may be lower in such cases. Another difference is that while an HMO plan requires a referral from a primary care physician before visiting a specialist, PPO plans do not have this requirement, and you can contact a specialist directly for treatment.

Private Fee-for-service (PFFS)
Like HMOs and PPOs, PFFS plans are provided by private insurance companies. But unlike the above policies, PFFS may not have a network. Even if they do, you can visit a service provider out of the network. The point to note here is that a doctor can accept or reject a PFFS plan’s terms and conditions on a patient-by-patient basis. You do not need a primary doctor referral to see a specialist and may get benefits beyond Medicare-approved terms, including prescriptions and vision coverage.

Special Needs Plan (SNP)
This plan covers people suffering from specific diseases, such as cancer, or those with particular healthcare needs. The policy is designed to benefit only such individuals. Therefore, you should go through the eligibility criteria to avoid any confusion. SNP plans are divided into three categories depending on the kind of diseases they cover: chronic condition SNP (C-SNP), institutional SNP (or I-SNP), and dual eligible SNP (or D-SNP).

Comparing the Medicare Advantage plans
Many find PPO more beneficial than HMO because you can visit out-of-network specialists and still receive some coverage. Also, those who have enrolled for PPO plans need not get any referral to seek a specialist. This helps save time. On the other hand, HMO enables you to save more money than PPO, but you cannot get the benefits of out-of-network doctors. If it is an emergency, you can seek help from out-of-network providers under both plans.

PFFS plans probably offer the most flexibility. Here, Medicare does not determine the amount to be charged by the beneficiaries, and the private insurance company does this task. However, it does not guarantee that every doctor will accept the plan’s payment terms.

While the first three plans benefit seniors (60 or above) and disabled citizens, SNP is different. It is only helpful for people suffering from a particular disease. So, you must compare the best-rated Medicare plans and choose one as per your need.

Companies with the best Medicare Advantage plans
Many private insurance companies in the market provide Part C plans, so choosing one can be tricky. Here are the best options to consider:

Kaiser Permanente
The HMO plan from this provider has received a five-star rating from Medicare. Beneficiaries have also given Kaiser Permanente positive reviews. The company has an Advantage Plus plan that can be added to the HMO policy to get added coverage for dental, hearing aid, and vision-related issues.

Humana
Humana is another popular Medicare Advantage plan service provider. It serves a larger area than Kaiser Permanente and offers more options. Humana also offers additional benefits, but you must opt for them at an extra cost.

UnitedHealthcare
It is a top health insurance provider in the country that covers all 50 states. UnitedHealthcare received four stars from Medicare, and it ranks better than Humana in terms of product and service quality.

The rating from Medicare keeps changing every year. However, Kaiser Permanente, Humana, and UnitedHealthcare are popular. Compare the policies of these companies and read the terms and conditions carefully before enrolling.

Why is it essential to compare Medicare Advantage plans?
There are many plans and providers on the market, each with unique benefits. So, comparing helps you choose the most suitable policy as per your need. You also get a deeper understanding of the different providers, their quality of services, and the number of in-network doctors and hospitals. This information will help you make an informed decision.

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