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Medicare Advantage Plan Comparison
Plan Comparison
HMO
Local PPO
Regional PPO
PFFS
Network Size
1 or more counties
1 or more counties
Larger area, such as statewide
Varies
Plan Availability
Most common MA plan
Most common PPO plan
Least common PPO plan
Only available in areas with less than 2 MA plans
Specified PCP
Yes
Usually, No
Usually, No
Usually, No
Referrals Required
Usually, Yes
No
No
No
Maximum Out-of-Pocket
Yes
In-network only
(no out-of-network benefits)
Yes
In-network and out-of-network
Yes
In-network and out-of-network
Yes
In-network and out-of-network
Summary
There are 4 main types of Medicare Advantage plans, including Private-Fee-For-Service (PFFS), Preferred Provider Organization (PPO), and Health Maintenance Organization (HMO) plans. We have discussed these plans in-depth, so let’s now compare them.
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PFFS plans offer the greatest overall healthcare provider options, in or out-of-network. Most plans include prescription drug coverage—if it does not, you have the option to add Medicare Part D to your plan, unlike HMO and PPO. If you prefer to have a wide range of coverage options, this plan may be a great fit for you.
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HMO plans have the smallest overall cost of the three. With this low cost, you will only be paying for the coverage you need as you need it. You must, however, stay within this network. If you prefer having the consistency of a primary care doctor that refers you to the specialists and prescriptions you need, an HMO plan may be best for you.
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If you prefer having access to out-of-network doctors, then a PPO may be better suited for you. This plan will work well for you if you travel and want less expensive care more regularly.