HMO (Health Maintenance Organization)
Requires you to use in-network providers and typically get referrals to see specialists. Often the lowest-cost option.
PPO (Preferred Provider Organization)
Offers more flexibility to see out-of-network providers (usually at higher cost) and generally doesn't require referrals.
SNP (Special Needs Plan)
Designed for people with specific conditions, dual Medicare/Medicaid eligibility, or who live in institutional care — benefits are tailored to those needs.
PFFS (Private Fee-for-Service)
Less common; the plan determines how much it pays providers and how much you pay, and not all providers will accept the plan's terms.
Key Takeaways
- HMO plans are typically lowest-cost but most restrictive on provider choice.
- PPO plans offer more flexibility at a higher potential cost.
- Special Needs Plans (SNPs) target specific chronic conditions or dual-eligible populations.
Plan structures vary by carrier and region. Always confirm specific plan rules before enrolling.
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