Medicare Advantage Plan Types Explained
Not all Medicare Advantage plans work the same way. The plan type determines how much network flexibility you have, whether referrals are required, and who the plan is generally designed for.
HMO
Health Maintenance Organization
You generally must use doctors and hospitals within the plan's network, and you typically need a referral from your primary care doctor to see a specialist. HMO plans usually have lower premiums and out-of-pocket costs in exchange for these restrictions.
PPO
Preferred Provider Organization
You have more flexibility to see providers outside the plan's network, though you'll usually pay more for out-of-network care. Referrals typically aren't required to see a specialist, which appeals to people who want more control over their care.
SNP
Special Needs Plan
Designed for people with specific circumstances: chronic conditions (like diabetes or heart failure), dual eligibility for Medicare and Medicaid, or those living in an institution such as a nursing home. Benefits and provider networks are tailored to those needs.
PFFS
Private Fee-for-Service
A less common plan type where the insurer sets payment terms and the individual provider decides, visit by visit, whether to accept them. Because provider participation isn't guaranteed in advance, it's worth confirming acceptance before each appointment.