Medicare Advantage

Types of Medicare Advantage plans.

Medicare Advantage plans come in five main types. HMOs require you to use a network of doctors and get referrals for specialists, and they have the lowest premiums. PPOs let you go in or out of network at higher cost. PFFS plans let you see any provider that accepts the plan's payment terms. MSA plans pair a high-deductible plan with a tax-advantaged savings account. SNPs (Special Needs Plans) are designed for people with specific conditions or dual Medicare-Medicaid status. HMOs and PPOs cover the vast majority of California enrollees.

HMO — Health Maintenance Organization

The most common type. You pick a primary care physician (PCP) within the plan's network. PCP coordinates your care and provides referrals to specialists. Outside-network care is generally not covered except in emergencies.

• Pros: Lowest premiums, predictable copays, often includes the most extras (dental/vision)
• Cons: Strictest network, referrals required, no coverage outside network
• Best for: People who like having a PCP coordinate care, don't travel much, and want low premiums

PPO — Preferred Provider Organization

More flexible than HMO. You can see in-network providers at lower cost, or go out-of-network at higher cost—no PCP referral required. Out-of-network is typically a higher copay or coinsurance, not a denial.

• Pros: Flexibility, no referrals, some out-of-network coverage
• Cons: Higher premiums than HMO, out-of-network can get expensive
• Best for: People who want network flexibility, see specialists directly, occasionally need out-of-area care

PFFS — Private Fee-for-Service

Less common. The plan sets payment terms; any Medicare-approved provider can choose to accept those terms on a per-visit basis. Some PFFS plans have networks; some don't.

• Pros: Maximum provider flexibility (in theory)
• Cons: Providers can decline to accept the plan's terms; coverage is unpredictable
• Best for: Mostly historical—few PFFS plans remain

MSA — Medical Savings Account

A high-deductible MA plan paired with a savings account funded by Medicare. Money in the account can be used for medical expenses tax-free. Doesn't include drug coverage—you'd add a standalone Part D.

• Pros: Lowest possible premium, tax-advantaged savings
• Cons: High deductible, complex, very few plans available
• Best for: Healthy, financially comfortable people who want tax-advantaged health savings

SNP — Special Needs Plans

HMO-style plans designed for specific populations: dual-eligible (Medicare + Medicaid), people with chronic conditions, or institutionalized people. Tailored benefits, formularies, and provider networks.



Full Special Needs Plans guide →

How to choose

1. List your doctors. Check which plans they're in-network with. This narrows the field fast.
2. List your medications. Each plan has a formulary; the same drug can be tier 2 on one plan and tier 4 on another.
3. List your priorities. Lowest premium? Maximum flexibility? Specific extras?
4. Compare. Plug all of that into the comparison and the right plan usually emerges. We'll do this with you in 30 minutes.
   

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