Medicare Advantage
Medicare Advantage (Part C) plans are offered by private insurers and may bundle hospital and medical coverage, often with additional benefits. Review networks, prescriptions, costs, and plan details before enrolling.
Medicare Advantage Plans (Part C)
Medicare Advantage Plans are an alternative way to receive your Part A (Hospital) and Part B (Medical) benefits. Offered by Medicare-approved private insurers, these plans must follow Medicare rules and often bundle extra benefits.
Common Medicare Advantage Plan Types
Open a plan type below to view key features and what’s typically included.
HMO — Health Maintenance Organization
Network-focused care that may help keep premiums and out-of-pocket costs lower.
An HMO Medicare Advantage plan is one of the most common ways to get Medicare benefits. These plans are designed to keep costs lower by using a network of doctors, hospitals, and other providers.
Key Features
- Network-Based Care: Generally use in-network doctors and hospitals (exceptions for emergencies/urgent care).
- Primary Care Physician (PCP): Most HMOs ask you to choose a PCP to coordinate your care.
- Referrals for Specialists: Typically required from your PCP to see a specialist.
- Lower Costs: Often lower premiums and out-of-pocket costs than other plan types.
What’s Included
- All benefits of Medicare Part A (Hospital) and Part B (Medical)
- Most HMOs also include Part D prescription drug coverage
- May include extra benefits like dental, vision, hearing, and wellness programs (varies by plan)
PPO — Preferred Provider Organization
More flexibility to see in-network or out-of-network providers (usually at different costs).
A PPO Medicare Advantage plan offers more flexibility than an HMO by allowing you to see providers both in-network and out-of-network.
Key Features
- No Primary Care Requirement: You don’t need to choose a PCP.
- No Referrals Needed: See specialists without a referral.
- Flexibility: Use out-of-network providers (you’ll usually pay more).
- Premiums & costs vary: Often higher than HMOs in exchange for broader access.
What’s Included
- All benefits of Medicare Part A (Hospital) and Part B (Medical)
- Many PPOs include Part D prescription drug coverage
- May include extra benefits (dental/vision/hearing/fitness), depending on the plan
PFFS — Private Fee-for-Service
Provider choice depends on whether the doctor/hospital accepts the plan’s payment terms.
A PFFS Medicare Advantage plan can offer flexibility in choosing providers. You can see any Medicare-approved doctor or hospital that accepts Medicare and agrees to the plan’s payment terms.
Key Features
- Any Medicare-Approved Provider: You can see providers who accept Medicare and agree to plan terms.
- No Primary Care Requirement: You don’t need to select a PCP.
- No Referrals Needed: Specialists typically don’t require referrals.
- Costs can vary: Payment terms and provider participation can impact out-of-pocket costs.
What’s Included
- All benefits of Medicare Part A and Part B
- Some plans include Part D; others may require a separate stand-alone Part D plan
- May offer extra benefits such as dental/vision/hearing (varies by plan)
SNP — Special Needs Plans
Designed for specific conditions, care settings, or dual-eligibility needs.
Special Needs Plans are Medicare Advantage plans tailored for people with specific health conditions, financial situations, or care needs. Benefits, networks, and drug formularies are designed to match members’ needs.
Key Features
- Targeted Coverage: Available only to people who meet specific eligibility criteria.
- Coordinated Care: Often includes care coordinators or case managers.
- Integrated Benefits: Medical, hospital, and drug coverage designed around member needs.
What’s Included
- All benefits of Medicare Part A and Part B
- Part D prescription drug coverage is typically included (varies by SNP type and plan rules)
- Extra benefits may include transportation, care coordination, or enhanced drug coverage (plan-specific)
Types of SNPs
A quick snapshot of the most common SNP categories.
C-SNP (Chronic Condition)
For people with severe or disabling chronic conditions (plan-specific eligibility).
D-SNP (Dual-Eligible)
For people who qualify for both Medicare and Medicaid, coordinating both programs.
I-SNP (Institutional)
For individuals living in institutions or needing nursing-level care at home.
Quick Overview — What most MA plans share
A fast checklist: coverage, networks, costs, and extra benefits.
Core Coverage
- Plans cover Part A (Hospital) and Part B (Medical) services.
- Many plans also include Part D (Prescription drugs).
- Benefits and costs can vary by plan and service area.
Costs & Protections
- Plans set a yearly out-of-pocket maximum for covered Part A/B services.
- Networks (HMO/PPO) can impact costs for in- vs. out-of-network care.
- Extra benefits like dental/vision/hearing vary by plan.
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