HMO Plans allow you to go to doctors, other health care providers or hospitals that are in-network except in an emergency. You may need to get a referral from your doctor.
You can't get your health care from just anywhere. You must get your care and services from doctors, other health care providers, or hospitals in the plan's network.
HMO plans have prescription drug coverage built right into the plan.
Most of the time yes, you need to choose a primary care doctor for an HMO Plans.
Usually Yes, Certain services, like yearly screening mammograms, don't require a referral.
If your doctor or other provider leaves, you will be notified. You can choose another doctor in the plan. If you get health care outside the network, you may have to pay full cost. It's important that you follow the plan's rules, like getting prior approval for a some services when needed.
PPO Plans are offered by private insurance companies. You pay less if you use doctors, hospitals, and other health care providers that belong to the PPO network . You may pay more if you go outside of the network.
You can get your health care from any doctor, other health care provider, or hospital in the plan. PPO Plans have doctors, other health care providers, and hospitals.
Every plan gives you the option to go to doctors, specialists, or hospitals that aren't on the plan's list, but will usually cost more.
Prescription drugs are covered by PPO Plans most of the time. If you want Medicare drug coverage, you have to join a PPO Plan that offers prescription drug coverage.
You don't need to choose a primary care doctor in PPO Plans.
You don't have to get a referral to see a specialist with PPO Plans. If you use plan specialists, your costs for covered services will usually be lower than if you use non-plan specialists.
PFFS Plan is a type of Medicare Advantage Plan offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
In some cases, you get your health care from any doctor, other health care provider, or hospital in PFFS Plans.You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan's payment terms and agrees to treat you. If you join a PFFS Plan that has a network, you can also see any of the network providers who have agreed to always treat plan members. You can also choose an out-of-network doctor, hospital, or other provider, who accepts the plan's terms, but you may pay more.
Prescription drugs may be covered in PFFS Plans. If your PFFS Plan doesn't offer drug coverage, you can join a Medicare Prescription Drug Plan to get coverage.
You don't need to choose a primary care doctor in PFFS Plans.
You don't have to get a referral to see a specialist in PFFS Plans.
Some PFFS Plans contract with a network of providers who agree to always treat you even if you’ve never seen them before. Out-of-network doctors, hospitals, and other providers may decide not to treat you even if you’ve seen them before.For each service you get, make sure your doctors, hospitals, and other providers agree to treat you under the plan, and accept the plan’s payment terms.In an emergency, doctors, hospitals, and other providers must treat you.Show your plan membership ID card each time you visit a health care provider. Your provider can choose at every visit whether to accept your plan’s terms and conditions of payment. You can’t use your red, white, and blue Medicare card to get heath care because Original Medicare won’t pay for your health care while you’re in the Medicare PFFS Plan. Keep your Medicare card in a safe place in case you return to Original Medicare in the future.You only need to pay the copayment or coinsurance amount allowed by the plan for the type(s) of service you get at the time of the service.
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
Generally, you must get your care and services from doctors or hospitals in the Medicare SNP network (except emergency or urgent care, such as care you get for a sudden illness or injury that needs medical care right away, or if you have End-Stage Renal Disease (ESRD) and need out-of-area dialysis). Medicare SNPs typically have specialists in the diseases or conditions that affect their members.
All SNPs must provide Medicare prescription drug coverage.
In most cases, SNPs may require you to have a primary care doctor, or the plan may require you to have a care coordinator to help with your health care.
In most cases, you have to get a referral to see a specialist in SNPs. Certain services, like yearly screening mammograms or an in-network pap test and pelvic exam (covered at least every other year), don't require a referral.
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
Generally, you must get your care and services from doctors or hospitals in the Medicare SNP network (except emergency or urgent care, such as care you get for a sudden illness or injury that needs medical care right away, or if you have End-Stage Renal Disease (ESRD) and need out-of-area dialysis). Medicare SNPs typically have specialists in the diseases or conditions that affect their members.
All SNPs must provide Medicare prescription drug coverage.
In most cases, SNPs may require you to have a primary care doctor, or the plan may require you to have a care coordinator to help with your health care.
In some cases, you may have to get a referral to see a specialist with SNPs depending on whether it acts as a PPO or HMO Special Needs Plan.
