The most popular types of MA Plans are the Health Maintenance Organization (HMO) Plans and Preferred Provider Organization (PPO) Plans. The HMO Plans are typically cheaper than PPOs, but they lack the flexibility of a PPO.
HMOs have a provider network that beneficiaries will generally have to receive their care and treatment from. If they go outside the network to receive care, the HMO Plan will not provide coverage. You may also be required to choose a primary care doctor within the plan’s network and get referrals to see specialists.
PPO Plans have a provider network, but you are not limited to receiving care within that network. You can go out of the network, but keep in mind that it will cost more if you do so. PPOs also do not require you to choose a primary care doctor or get referrals.
While Medicare Advantage Plans offer the same coverage as Original Medicare and include additional benefits, the plans can still fall short. For example, these plans are nothing like Medicare Supplements. MA Plans do not provide coverage for the costs left behind by Original Medicare, such as deductibles, coinsurance, or copayments. This can lead to your out-of-pocket costs building up over time.
Some of the MA Plans also have restrictions and rules, and to keep receiving coverage, you must follow them. As mentioned above, some plans have provider networks that they require their enrollees to use if they want the coverage. This means if you travel or move, you will not receive coverage, or you will need to find new coverage within your area. The only exception to receiving care outside of your plan’s service area or network is if it’s an emergency.