Medicare Advantage Networks

In exchange for lower premiums that Advantage plans offer, you agree to play by certain rules. Most Medicare Advantage plans have HMO or PPO networks.

Medicare HMO networks generally require to treat only with network providers, except in emergencies. You will usually need to select a primary care physician. That physician can coordinate a referral if you need to see a specialist. There some HMO plans that offer a point-of-service feature where you can see out-of-network providers in certain circumstances.

Medicare HMO plans are the most prevalent type of network. According a study by Mark Farrah associates, they will represent 71% of all Medicare Advantage plans on the market.

Medicare PPO networks allow you to see doctors outside the network but you’ll have substantially higher out-of-pocket spending to do so.

In some counties, there are Medicare Private-Fee-for-Service plans (PFFS). These plans may or may not include Part D. How you access care is also different. While this plan type was very common in the past, it has been slowly phased out in most areas

Medicare MSA Accounts (Medicare Savings Accounts) accompanied by a High Deductible Health Plan have also entered the Medicare Advantage Marketplace.  These plans are similar to a PFFS plan where the medical provider can choose on a case by case basis if they will accept this type of insurance.  For this reason please consult with an agent before you enroll in this type of plan.