HMO
HMO stands for Health Maintenance Organization. With an HMO plan, you must choose a Primary Care Physician (PCP) from a network of a local healthcare providers who will refer you to in-network specialists or hospitals when necessary. All you care is coordinated through that PCP.
An HMO gives you access to certain doctors and hospitals within its network. A network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards.
PPO
A preferred provider organization (PPO) is a type of health insurance arrangement that allows plan participants relative freedom to choose the doctors and hospitals they want to visit. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You pay more if you use Doctors, hospitals and providers outside of the network.
PDP
A prescription drug plan (PDP) is one option for the individuals who wants to enroll in the Medicare Part D prescription drug coverage, which subsidizes the costs of prescription drugs for enrollees.
SNP
Special Needs Plan (SNP) is a special type of coordinated care in Medicare Advantage (Part C), this refers to a kind of health car plan that links providers and services to deliver efficient, cos-effective patient care.
Medicare SNPs are a type of Medicate Advantage Plan (Like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
3 types of SNP
Health plan for people with limited incomes. These plans are for the people that are considered to be dual eligible. Dual eligible means that the person is enrolled in both Medicare and qualifies and is enrolled in their State’s Medicaid program.
Health plan for people with specific long term illnesses. This type of plan is considered to be a chronic illness Special Needs Plan. It is designed to meet the needs of those with specific enrollment criteria as defined by their having a qualifying chronic illness. Plan may include; cardiovascular disorders, chronic heart failure, diabetes and other qualifying disorders. These plan typically offer a higher level of coordinated care than other Medicare Advantage Plans.
Health plan for people in nursing homes. The key to eligibility for this plan is residency in a nursing homes.
MCO
Managed Care Organizations (MCOs) – Like HMOs, these companies agreed to provide most Medicaid benefits to people in exchanged for a monthly payment from the state. Private insurance companies may offer health plans for Medicaid recipients and these are considered Medicaid MCOs.
Umbrella
Aetna
| Individuals/ Family Plans | Employers | Medicare | Medicaid |
| HMO– Aetna leap Everyday | HMO– Aetna Whole Health PPO– Aetna Value plan | HMO– Aetna Medicare choice PPO– Advantra ONE HMO– Aetna Medicare Standard SNP– Coventry Health Care PDP | MCO– Aetna Better Health |