Medicare Advantage Plan Network Types
A plan network is the facilities, providers, and suppliers your health insurance carrier or plan has contracted with to provide health care services. The network types available with Medicare Advantage plans include:
Health Maintenance Organization (HMO)
HMOs are the most restrictive of the network types. You generally must get your care and services from doctors, other health care providers, or hospitals in the plan’s network (except emergency or urgent care or out-of-area dialysis). You are required to select an in-network primary care physician (PCP) to manage your care. Referrals are required to see other providers or specialists; however they aren't required for emergencies. Benefits aren't paid if care is received from out-of-network providers, except in an emergency.
Preferred Provider Organization (PPO)
Each plan has a network of doctors, hospitals, and other health care providers that you may go to. You may also go out of the plan’s network, but your costs may be higher. You don't need to choose a PCP, and referrals aren't required.
Private Fee-for-Service (PFFS)
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 the plan has a network, you can use any of the network providers, but if you go to an out-of-network provider that accepts the plan’s terms, you may pay more. You don't need to choose a PCP, and referrals aren't required.
Health Maintenance Organizations - Point of Service (HMO-POS)
Health Maintenance Organizations - Point of Service (HMO-POS) is an HMO with a more flexible network that allows you to seek care outside of the traditional HMO network under certain situations or for certain treatment. The plan may allow you to access some services out-of-network, or without a referral or prior approval for a higher cost. You must choose a PCP from the POS network.