Medicare Private fee for service (PFFS) plans are sold by private insurance companies as a type of Medicare Advantage plan.   By law, Medicare Advantage plans must offer at least as much coverage as Original Medicare and may operate as HMOs, PPOs, or Private Fee for Service Plans.

With a Medicare PFFS plan, you can see any Medicare‐approved healthcare provider who accepts your insurance plan&rquo;s payment rates and agrees to treat you.  Plus, you do not need a referral from your primary care doctor to see a specialist.

Special Needs Plans provide benefits and services to people with specific diseases, certain health care needs, or who also have Medicaid coverage.  SNPs tailor their benefits, provider choices, and list of covered drugs to best meet the specific needs of the groups they serve.

Each SNP limits its membership to people in one of these groups, or a subset of one of these groups.  You can only stay enrolled in an SNP if you continue to meet the special conditions that the plan serves.

An HMO plan is a type of Medicare Advantage Plan that generally provides health care coverage exclusively from doctors, other health care providers, or hospitals in the plan’s network (except emergency care, out‐of‐area urgent care, or temporary out‐of‐area dialysis).

If you get non-emergency health care outside the plan’s network without authorization, you may have to pay the full cost.   If you join an HMO plan without drug coverage, you can’t join a separate Medicare drug plan.

Medicare PPO plans, formally known as Medicare Advantage PPOs, provide people on Medicare with the freedom to see doctors outside of the plan’s network without needing to pay the full cost of coverage out‐of‐pocket.  If you join a PPO plan without drug coverage, you can’t join a separate Medicare drug plan.

You can use out‐of‐network providers for Medicare‐covered services, but you might pay a higher copayment or coinsurance amount outside the network.  Before you get care outside the network, make sure the provider agrees to treat you and hasn’t opted out of Medicare.  Your Medicare Advantage plan covers emergency out‐of‐network care.

A Medicare Medical Savings Account plan is a type of Medicare Advantage plan that combines a high-deductible health plan with a medical savings account.  Enrollees of Medicare MSA plans can initially use their savings account to help pay for health care, and then will have coverage through a high‐deductible insurance plan once they reach their deductible.  Medicare MSA plans provide Medicare beneficiaries with more control over health care utilization, while still providing coverage against catastrophic health care expenses.

Each Medicare PPO plan has an out‐of‐pocket maximum in place to cap your out‐of‐pocket costs.  Once you reach the out‐of‐pocket maximum, the Medicare PPO plan picks up 100% of your healthcare costs.