Medicare Advantage Plan Definitions

​

There are many types of plans available throughout California, but not
all types are available in Fresno California. Here are the available types
of Medicare Part C (Advantage) plans in California.   

​

​

HMO = Health Maintenance Organization

 

Typically associated with "networks" such as doctors, specialists and hospitals. HMO's require a referral by your Primary Care Physician in order to see a specialist. Normally less expensive co-pays and greater benefits vs a PPO or POS plan.

​

PPO = Preferred Provider Organization

​

A PPO is a plan that has a network (like an HMO), but allows you to step out of that network and obtain services at virtually any doctor, specialist or hospital. The insurance company will still participate in the share-of-costs, but your share will be higher than if you stayed within the PPO network.  No referrals are required with a PPO plan.

​

POS = Point Of Service

​

This is an HMO with an additional benefit, if you want to venture outside of the established network of providers, you can.  You must first verify that the provider you want to use will accept the payment of the insurance carrier prior to receiving services from the out-of-network provider.  Out-of-network services will cost more.

​

SNP = Special Needs Plan

​

A specials needs plan is designed for those receiving extra financial help from the state or government.  To qualify for a SNP plan, either a low-income subsidy (LIS) is required, or you must be receiving some level of Medi-Cal benefits from the state.  SNP plans have $0 costs for all services. Some include comprehensive dental, unlimited transportation and extra benefits such as Coordinated Services.