CRACKING THE CODE Understanding Medicare Parts C and D

Chapter 2: Exploring Medicare Part C (Medicare Advantage)

Types of Medicare Advantage Plans Available

Medicare Advantage plans come in various types, each with its own structure and coverage options. The most common types of Medicare Advantage plans include:

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Health Maintenance Organization (HMO) Plans: HMO plans typically require beneficiaries to use doctors and hospitals within the plan's network and may require referrals from a primary care physician for specialist care.

Preferred Provider Organization (PPO) Plans: PPO plans offer more flexibility in choosing healthcare providers, allowing beneficiaries to use both in-network and out-of-network providers. However, out-of-network care usually comes with higher out-of-pocket costs.

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Private Fee-for-Service (PFFS) Plans: PFFS plans determine how much they will pay for doctors, hospitals, and other healthcare services, and how much beneficiaries will pay when they receive care. Providers must accept the plan's terms and conditions to provide services.

Special Needs Plans (SNPs): SNPs are tailored to meet the specific needs of beneficiaries with certain chronic conditions, disabilities, or other characteristics. These plans often offer targeted benefits and care coordination services for enrollees.

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