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ADVANTAGE Health Solutions, Inc., Medicare Advantage Offerings
Summary of Benefits
A Preferred Provider Organization (PPO) is a type of Medicare Advantage plan that allows you to see in-network doctors or out-of-network doctors. Member cost-sharing may be higher when plan benefits are received from out of network providers, except in an emergency.



A Health Maintenance Organization (HMO) is a type of Medicare Advantage plan that requires you to choose a primary care physician from a network of approved healthcare providers. If you need to see a specialist, you must have a referral from your primary care doctor. You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor ADVANTAGE Health Solutions will be responsible for the costs.



The ADVANTAGE Special Needs Plan is a Health Maintenance Organization (HMO) designed for individuals who qualify for both Medicare and Medicaid. As a member of an HMO, you must use plan providers except in emergency or urgent care situations, or for out of area renal dialysis. If you obtain routine care from out of network providers, neither Medicare nor ADVANTAGE will be responsible for the costs. If you are currently responsible for Part B premiums (based on your category of Medicaid coverage), you must continue to pay these premiums.