Medicare Advantage Plans, also called “Part C” or “MA Plans,” are an alternative to Original Medicare for receiving your Part A and Part B benefits. These plans are offered by Medicare-approved private insurers and must follow Medicare guidelines. Most include prescription drug coverage (Part D) and require you to use providers within the plan’s network. They also limit your annual out-of-pocket costs for covered services. Some plans may offer limited out-of-network coverage for non-emergency care, usually at a higher cost.
Below are the most common types of Medicare Advantage Plans.
Health Maintenance Organization (HMO)
With HMO plans, you generally must get care and services from doctors, hospitals, and other providers within the plan’s network. Exceptions are made for:
Emergency care
Urgent care when you’re outside the plan’s service area
Temporary dialysis outside your coverage area
Some HMO plans, known as HMO Point-of-Service (HMOPOS) plans, offer added flexibility by allowing you to access certain out-of-network services, though you’ll typically pay a higher copayment or coinsurance for those services.
Preferred Provider Organization (PPO)
PPO plans feature a network of doctors, hospitals, and healthcare providers. You’ll save money by using in-network providers, but you also have the option to receive care from out-of-network providers for covered services—usually at a higher cost.
To be covered, the provider must be willing to treat you and must not have opted out of Medicare for Part A and Part B services. Emergency and urgent care are always covered, regardless of where you get treatment.
Private Fee-for-Service (PFFS) Plans
PFFS plans are different from Original Medicare and Medigap. These plans decide how much they will pay healthcare providers and how much you’ll pay when receiving care. The costs and payment terms are set by the plan—not Medicare.
Special Needs Plans (SNP)
Medicare Special Needs Plans (SNPs) are tailored for people with specific health conditions or circumstances. These plans offer customized benefits, specialized provider networks, and prescription drug coverage designed to address the unique healthcare needs of their members.
Other less common types of Medicare Advantage Plans
Other less common types of Medicare Advantage Plans that may be available include HMO Point of Service (HMOPOS) Plans and a Medicare Medical Savings Account (MSA) Plan.
Covered services in Medicare Advantage Plans
Medicare Advantage Plans often include extra benefits beyond what Original Medicare offers. These can include fitness programs like gym memberships or discounts, as well as vision, hearing, and dental services such as routine exams and cleanings. Some plans also provide additional perks like transportation to medical appointments, coverage for over-the-counter medications, and wellness services to help maintain your overall health.