HMO (Health Maintenance Organization) plans have a providers’ network, except for emergency care or out-of-area urgent care or out-of-area dialysis. Some plans are a combination of an HMO and POS or an HMO and PPO plan. This means you would pay higher cost for out-of-network POS or PPO care. Most plans offer prescription coverage, and you cannot have a stand-alone Part D plan at the same time. Most plans require you to select a primary care provider or clinic. Some plans require prior approval for certain services.
POS (Point of Service) plans generally have you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans also require you to get a referral from your primary care doctor to see a specialist.
PPO (Preferred Provider Organizations) plans have network doctors, other health care providers, and hospitals. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network. In most cases, you can get your health care from any doctor, other health care provider, or hospital in PPO Plans. You do not have to select a primary care physician. Some plans have “preferred” provider networks. Each plan gives you flexibility to go to doctors, specialists, or hospitals that are not on the plan's list, but it will usually cost more. Most plans include prescription coverage. If you join a PPO Plan that does not offer prescription drug coverage, you cannot join a stand-alone Part D prescription plan.
PFFS (Pay for Fee Services) plans determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care. 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. You do not have to select a primary care physician or have a referral to get care. If you join a PFFS Plan that has a network, you can also see any of the network providers who have agreed to treat plan members. You can also choose an out-of-network doctor, hospital, or other provider, who accepts the plan's terms, but your costs will usually be lower if you stay within the network.
Medicare Savings Accounts
MSA (Medicare Savings Accounts) combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs. MSA plans do not include Part D prescription coverage and you would need to enroll in a stand-alone Part D plan. The high-deductible health plan will only begin to cover your costs once you meet a high yearly out-of-pocket deductible. The MSA Plan deposits money into your account, generally held by your bank. You can use money from this savings account to pay your health care costs before you meet the deductible.