Types of Medicare Plans

Centene Dental administers dental benefits for various types of Medicare Advantage plans. The member’s Evidence of Coverage documents describes all of the MA plan rules, including rules for prior authorization and rules for going to network or out-of-network providers.

Health Maintenance Organizations (HMOs)

An HMO is a type of Medicare Advantage Plan (Part C) plan. HMO members generally must get care and services from providers in the plan's network. Members may get care from out of network providers in limited circumstances, e.g., emergency care and out-of-area urgent care.

Health Maintenance Organization Point-of-Service (HMO-POS)

An HMO-POS plan is a type of Medicare Advantage (Part C) plan. HMO-POS plans have network providers that members can go to care. HMO-POS plans also allow members to get some services (like routine dental) from out-of-network providers, usually for a higher copayment or coinsurance.

Preferred Provider Organizations (PPOs)

A PPO is a type of Medicare Advantage Plan (Part C) plan. PPO members can go to the plan’s network providers. Members pay less if they go to network providers. Also, members can generally go to out of network providers for all covered services, but usually for a higher copayment or coinsurance.

Private-Fee-For-Service (PFFS)

A PFFS plan is a type of Medicare Advantage (Part C) plan. A PFFS plan can offer full or partial networks of providers, or, in certain cases, they may not use a network of providers at all. Centene Dental Services has a network of dental providers. PFFS members can see network providers. PFFS members can also see any dental provider who is eligible to receive payment from Medicare and agrees to accept the plan's terms and conditions of payment, but usually for a higher copayment or coinsurance.