Medicare Advantage Plan Types

Medicare Advantage plans come in four main types: HMO, PPO, PFFS, and SNP. Each has different rules about which providers you can see, whether you need referrals, and how much you pay.

The Four Types of Medicare Advantage Plans

HMO (Health Maintenance Organization)

Lower costs, network restrictions

Pros

Lower monthly premiums than PPO plans
Lower out-of-pocket costs for in-network care
Coordinated care through a primary care physician
Prescription drug coverage usually included

Cons

Must use in-network providers (except emergencies)
Requires referrals to see specialists
Cannot see out-of-network doctors without paying full cost

Best For

Beneficiaries who want lower costs and are comfortable with a network of providers.

Learn more about HMO plans

PPO (Preferred Provider Organization)

More flexibility, higher costs

Pros

Can see any Medicare-accepting provider
No referrals needed for specialists
Lower costs for in-network providers
More flexibility than HMO plans

Cons

Higher premiums than HMO plans
Higher cost-sharing for out-of-network care
Still have an annual out-of-pocket maximum

Best For

Beneficiaries who want flexibility to see specialists without referrals.

Learn more about PPO plans

PFFS (Private Fee-for-Service)

Flexible, but provider acceptance varies

Pros

Can see any Medicare-accepting provider who accepts the plan's terms
No network restrictions in most cases
No referrals required

Cons

Providers must agree to the plan's payment terms
Not all providers accept PFFS plans
Can be more expensive than HMO plans

Best For

Beneficiaries in rural areas with limited network options.

Learn more about PFFS plans

SNP (Special Needs Plan)

Tailored for specific health conditions

Pros

Tailored benefits for specific conditions (diabetes, heart disease, etc.)
Coordinated care for complex health needs
May include additional benefits relevant to the condition
Available for dual eligibles (Medicare + Medicaid)

Cons

Must meet eligibility criteria to enroll
Limited availability — not available in all areas
Network restrictions apply

Best For

Beneficiaries with chronic conditions, dual eligibles (Medicare + Medicaid), or those in institutional care.

Learn more about SNP plans

Quick Comparison

Feature	HMO	PPO	PFFS	SNP
Network required	Yes	Preferred	No (varies)	Yes
Referrals needed	Usually	No	No	Usually
Out-of-network care	Emergency only	Yes (higher cost)	Yes (if accepted)	Emergency only
Typical premium	Low	Medium-High	Varies	Low-Medium
Drug coverage	Usually included	Usually included	Sometimes	Usually included
Availability	Most areas	Most areas	Some areas	Limited areas

Medicare Advantage Plan Types

The Four Types of Medicare Advantage Plans

HMO (Health Maintenance Organization)

PPO (Preferred Provider Organization)

PFFS (Private Fee-for-Service)

SNP (Special Needs Plan)

Quick Comparison

Frequently Asked Questions