Medicare Advantage Plans

Medicare Advantage plans (also called Part C) are offered by private insurance companies and usually cover all services included in Parts A and B. They may even offer extra coverage like vision, hearing, dental, as well as health and wellness programs. Most plans also include prescription drug coverage (Part D).

  • You must be enrolled in Parts A and B of Medicare to sign up for a Medicare Advantage plan.
  • Different Medicare Advantage plans cover different services at different costs. You need to do your research to find a plan that fits your needs and budget.    
  • All Medicare Advantage plans limit the amount you will have to pay out-of-pocket each year. This allows you to budget more efficiently than Original Medicare, which has no limit on how much you may be responsible for.
  • Medicare Advantage Part D – Plans that include prescription drug coverage allow you to get both your health care and prescription drug coverage from the same private insurance company in a single plan.
  • Every insurance company that offers these plans has a contract with the federal government that is renewed annually.

Types of Medicare Advantage plans

There are a variety of Medicare Advantage plans available to meet individual needs, including the following coordinated care plans: 

Health Maintenance Organization (HMO) Plan

  • Must use doctors who belong to the plan.
  • Must go to hospitals within the network.
  • If you go outside of the network, you have to pay for your own care (except for emergency services, which are covered worldwide, and urgent care and renal dialysis, which are covered nationwide).
  • You will be required to choose a primary care physician.
  • Primary care physician may manage care received from specialists.
  • You may need a referral from your primary care physician to see a specialist.

Preferred Provider Organization (PPO) Plan

  • More likely to have freedom to choose your doctor.
  • Typically don’t need a referral to see a specialist.
  • Can see doctors outside the network that participates with Original Medicare for a higher share of the cost.

Point of Service (POS) Plan

  • Allows members to visit doctors and hospitals outside of the network – typically with a higher copay or coinsurance.
  • Some plans do not require referrals for specialty services.
  • May have a limit on out-of-network covered services

Special Needs Plan (SNP)

  • Coordinated care plans designed for people with special needs.
  • Combines hospital, doctor visits, outpatient care and prescription drugs in a single plan.
  • Usually includes well-coordinated care, and may offer a manager or nurse practitioner, as an advocate for the member.
  • Examples of people who may be eligible for SNP:
    • People in nursing homes or long-term care facilities
    • People eligible for Medicare and Medicaid (Dual Eligible Special Needs Plans)
    • People with select chronic diseases

NOTE: There are other Medicare Advantage plan options available. For more information, visit www.medicare.gov.