Medicare Acronyms To Remember

PCP (Primary Care Provider)
The main doctor or provider who manages a beneficiary’s overall health and gives referrals for specialists or services in certain plan types (like HMO's).

HMO (Health Maintenance Organization)
A Medicare Advantage plan type where you must use in-network providers and get referrals from your PCP to see specialists (except emergencies).

PPO (Preferred Provider Organization)
A Medicare Advantage plan with more flexibility—allows visits to out-of-network providers (usually at a higher cost) and doesn't require referrals.

POS (Point of Service)
A type of HMO plan that allows some out-of-network services, often with a higher copay or coinsurance. Requires PCP and referrals, but with more flexibility than a standard HMO.

PFFS (Private Fee-for-Service)
A Medicare Advantage plan that determines how much it will pay doctors and hospitals and how much you must pay. Some PFFS plans have networks, others don’t.

SNP (Special Needs Plan)
A Medicare Advantage plan designed for people with specific diseases, dual eligibility (Medicare & Medicaid), or those in institutions. Provides tailored care.

C-SNP (Chronic Condition Special Needs Plan)
A type of SNP for people with certain chronic conditions (e.g., diabetes, COPD, heart disease). Care is coordinated around those specific health needs.

D-SNP (Dual Eligible Special Needs Plan)
A type of SNP for individuals who qualify for both Medicare and Medicaid. Offers coordinated care and extra benefits for low-income beneficiaries.

I-SNP (Institutional Special Needs Plan)
A type of SNP for individuals living in nursing homes or who need nursing care at home for 90 days or longer.

MA (Medicare Advantage)
Also known as Part C; an alternative to Original Medicare that bundles Part A, Part B, and usually Part D into one private plan.

MAPD (Medicare Advantage Prescription Drug Plan)
A Medicare Advantage plan that includes prescription drug coverage (Part D).

MSA (Medical Savings Account)
A high-deductible Medicare Advantage plan combined with a savings account you can use for medical expenses.

Finding the right plan for your needs

• There’s no one-size-fits-all. Every Medicare Advantage plan has different premiums, networks, and benefits—what works for someone else may not work for you.

• Benefit trade-offs are common. You might get great dental but limited hearing aid coverage, or strong vision but weaker over-the-counter benefits.

• Lower copays usually mean fewer extras. Plans with lower out-of-pocket costs tend to offer less robust ancillary benefits like dental, vision, or fitness perks.

• Network types matter.

  • HMO = lower cost, smaller local network, referrals needed.

  • PPO = larger network, more flexibility, higher costs.

  • POS/PFFS = more options, but less predictability.

• Your needs change—your plan should too. A new health condition, medication, or move can make your current plan less ideal.

• That’s why having a broker matters.

  • They shop nearly every carrier in your area.

  • Help you compare real differences in benefits and costs.

  • Offer free, unbiased guidance year after year.

• No extra cost to you. Brokers are paid by the carriers, so their help costs you nothing—but can save you a lot.

Types of Plan Networks

HMO (Health Maintenance Organization)

What it means:
An HMO plan requires members to use a specific network of doctors and hospitals. Care must be coordinated through a Primary Care Physician (PCP), and referrals are needed to see most specialists.

Key features:

PCP required

Referrals needed for specialists

No coverage outside the network (except in emergencies or urgent care)

Usually has lower monthly premiums and out-of-pocket costs

Who it's best for:
Someone who wants lower costs and is okay with a more limited provider network and going through a PCP

PPO (Preferred Provider Organization)

What it means:
A PPO plan offers more flexibility in choosing healthcare providers. Members can see any doctor or specialist, but they’ll pay less when staying in-network.

Key features:

No PCP required

No referrals needed for specialists

Out-of-network coverage available, but more expensive

Usually higher premiums than HMO plans

Who it's best for:
People who want freedom to choose doctors without referrals, even if it means paying more.

POS (Point of Service)

What it means:
A POS plan combines elements of HMO and PPO. You choose a PCP and need referrals for specialists, but you have limited out-of-network coverage if you're willing to pay more.

Key features:

PCP required

Referrals needed

Out-of-network care is partially covered, but higher cost

Balances cost savings of HMO with flexibility of PPO

Who it's best for:
Those who want coordinated care but also want some flexibility to go out of network if necessary.

PFFS (Private Fee-for-Service)

What it means:
A PFFS plan lets members see any Medicare-approved provider who agrees to accept the plan’s payment terms. No network restrictions, but providers must accept the plan on a case-by-case basis.

Key features:

No network — freedom to choose providers

No PCP or referrals required

Doctors/hospitals can refuse to accept the plan, even if they previously accepted it

Costs and coverage can vary widely

Who it's best for:
Someone who wants maximum freedom, but is okay with doing extra legwork to find providers who accept the plan.

When Can You Enroll?

Initial Enrollment Period (IEP)

When: 7-month window around 65th birthday
Who: New to Medicare (age 65 or disabled)
What You Can Do:

Enroll in Parts A & B

Join a Medicare Advantage (Part C) plan

Join a Part D drug plan

Buy a Medigap (supplement) policy

Annual Enrollment Period (AEP)

When: October 15 – December 7
Who: All Medicare beneficiaries

What You Can Do:

Switch from Original Medicare ↔ Medicare Advantage

Switch Advantage plans

Join, drop, or switch a Part D plaN

Changes Take Effect: January 1

Medicare Advantage Open Enrollment Period (MA OEP)

When: January 1 – March 31
Who: People currently enrolled in a Medicare Advantage plan

What You Can Do:

Switch Advantage plans

Drop Advantage and return to Original Medicare (and join Part D)

Note: Cannot switch from Original Medicare to Advantage during this period.

Medigap (Supplement) Enrollment Period

When: 6 months after you’re 65 and enrolled in Part B
Who: Those wanting Medigap (to pair with Original Medicare)
What You Can Do:

Buy any Medigap plan with no health questions asked

Note: After this period, underwriting may apply.

Special Enrollment Periods (SEPs)

When: Varies by life event
Who: People with qualifying circumstances (e.g., moved, lost coverage, Medicaid changes)
What You Can Do:

Enroll in, switch, or drop Part A, B, C, or D plans

Avoid penalties with valid SEP reason

Examples: Moved, lost employer coverage, gained/lost Medicaid, plan termination

Medicare Advantage Vs. Medicare Supplement

What Is Medicare Advantage (Part C)?

Offered by private insurers as an all-in-one alternative to Original Medicare

Includes Part A, B, and usually Part D (prescription drugs)

May include dental, vision, hearing, OTC, fitness, and more

You still pay your Part B premium

Low or $0 monthly plan premiums

Uses provider networks (HMO or PPO)

Copays/coinsurance apply when you use services

Annual maximum out-of-pocket protection

Benefits and costs can change each year

What Is a Medicare Supplement (Medigap)?

Works alongside Original Medicare (Parts A & B)

Covers some or all deductibles, copays, and coinsurance

No extra benefits (dental, vision, hearing, prescriptions)

Requires separate Part D drug plan

Higher monthly premiums, but fewer surprise costs

No network restrictions—see any doctor who accepts Medicare

Coverage is stable year after year

May require medical underwriting if enrolling late

Which One Is Right for You?

Choose Medicare Advantage if

you prefer:

Lower premiums

Extra perks (dental, vision, OTC, etc.)

Don’t mind provider networks or copays

Choose Medicare Supplement if

you prefer:

Maximum flexibility with doctors

Fewer bills and more predictable costs

Travel freedom and long-term stability