Types of Products
There are four types of Medicare Advantage products under the Medicare Modernization Act of 2003.
Coordinated care plans
Coordinated care plans use a network of health care providers that have a contract with a health care organization to deliver a CMS-approved benefit package. These include:
- Health maintenance organizations
- Provider sponsored organizations
- Preferred provider organizations
Medicare savings account plans
Medicare savings account plans also use a network of health care providers, but combine a high-deductible benefit package and a medical savings account.
Private fee-for-service plans
As of 2011, private fee-for-service plans are required to use a network of health care providers.
Members can see any health care provider in their network who is eligible to receive payment from Medicare and who agrees to accept payment from the plan.
Private fee-for-service plans publish the terms and conditions that health care providers must follow if they choose to provide services to a private fee-for-service member.
Special needs plans
Special needs plans focus on certain at-risk Medicare members who are institutionalized, dual-eligible and have severe or disabling chronic conditions.
SNPs can improve care for Medicare beneficiaries with special needs in several ways:
- Improve coordination and continuity of care
- Offer enhanced benefits to dual-eligible members by combining those available through Medicare and Medicaid
- Focus on monitoring health status, managing chronic diseases, avoiding inappropriate hospitalizations and helping members move from high risk to lower risk on the care continuum
Specific legislative and regulatory provisions allow SNPs to focus on certain segments of the Medicare population with the intent to improve care and control costs for these members.