When you’re deciding whether Medicare Advantage is the right fit for your health and financial goals, you may benefit from learning about the different types of plans that are offered. There are a few different types, including HMO, PPO, PFFS, and SNP. We’ll also offer a comparison of HMO vs. PPO, the two most common plan types.

Network Plans

Health Maintenance Organization (HMO)

A Medicare HMO is a type of Medicare Advantage plan that offers coverage through a network of providers, as well as an out-of-pocket maximum. This is a popular plan type because of the convenience of having all of your providers in a single network, as well as a cap on how much money you will pay out-of-pocket. Because you must stay within your network to stay covered, many HMO plans will have you select a primary care physician. Most HMO plans offer prescription drug coverage and require you to get a referral to see a specialist. You will always be covered in an emergency, even if you are outside of your network.

Preferred Provider Organizations (PPO)

A Medicare PPO is a Medicare Advantage plan that offers coverage for healthcare providers and services both in- and out-of-network. Because you don’t need to visit a doctor or provider within your network, you do not need to choose a primary care physician or have a referral to see a specialist. It’s typically more cost effective to see a preferred in-network provider, but you can still visit an out-of-network provider for a higher cost, as long as the provider accepts Medicare. Most PPO plans include prescription drug coverage, and you are always covered in case of an emergency.

Private Fee-for-Service (PFFS)

Medicare PFFS is a Medicare Advantage plan. These plans determine how much you pay for each service. Providers can choose whether they will accept your PFFS plan’s terms on a visit-to-visit basis so when you visit a hospital, physician, or specialist, it’s important to confirm they will accept your plan’s terms prior to each visit. Because you can go to any Medicare-approved provider, you don’t need to select a primary physician or get a referral to see a specialist. You will always be covered in case of an emergency.

Special Needs Plan (SNP)

Medicare Advantage SNPs are only available if you have a special circumstance, disability, or disease. For example, being dual eligible or having End-Stage Renal Disease may qualify you. All Special Needs Plans offer prescription drug coverage. Due to the nature of the plan, most SNPs have a network of specialists that target the specific type of need. In most cases, you will need to select a primary care physician and get a referral to see a specialist.

HMO vs. PPO

Medicare Advantage HMO and PPO plans are the most common plan types. Let’s compare HMO vs. PPO using the metrics for consideration above, including network, primary care physician, prescription drug coverage, referrals for specialists, and cost:

As for all plans, some HMO or PPO plans may vary slightly in what’s offered or covered, so it’s best to check with the specific plan you are considering before committing.

There are other plan types, but they are significantly less common. Alternative Medicare Advantage plans include:

• Medicare Medical Savings Account (MSA): A high-deductible plan that offers money deposited in a medical savings account. You can use this account to pay for your health services. The amount deposited is often less than the deductible amount, which means you will be paying out-of-pocket until you’ve met your deductible.
• Health Maintenance Organization Point-of-Service (HMO POS): These plans may let you obtain coverage out-of-network for a higher out-of-pocket cost.

Enrollment Eligibility

e-TeleQuote Insurance Inc. (“e-TeleQuote”) does business as easyMed Insurance Services in all states other than New Mexico. e-TeleQuote is a duly licensed insurance agency appointed by Medicare Advantage HMO, PPO and PFFS plans and stand-alone prescription drug plans and insurance companies holding Medicare contracts approved by The Centers for Medicare & Medicaid Services (CMS). e-TeleQuote is not connected with or endorsed by the U.S. Government or the Federal Medicare Program. Enrollment in any plan for coverage is subject to insurance company approval. Enrollment in the plan depends on the plan’s contract renewal with Medicare. By using e-TeleQuote’s easyMedicare website, you understand and agree that in New Mexico, we operate as e-TeleQuote Insurance, Inc. (Your IP address and/or location coordinates may be gathered to verify your location.) Sales agents may be compensated based on your enrollment in a health plan. Medicare Supplement plans are not connected with or endorsed by the U.S. Government or the Federal Medicare program. e-TeleQuote complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. easyMedicare.com is a non-government site, powered by e-TeleQuote Insurance, Inc. e-TeleQuote provides a secure way to purchase Medicare insurance from the comfort of your home or workplace. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-Medicare (TTY users should call 1-877-486-2048) 24 hours day/7 days a week, or your local State Health Insurance Program (SHIP), to get information on all of your options. Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.