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 the network, you have to pay for your own care (except for emergency, urgent services, and renal dialysis, which is 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.