Medicare
advantage
A Medicare Advantage Plan is a health insurance option provided by private companies that contract with Medicare to deliver your Part A and Part B benefits.
These plans come in various types, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) Plans, Special Needs Plans (SNPs), and Medicare Medical Savings Account (MSA) Plans.
When you enroll in a Medicare Advantage Plan, your Medicare services are covered through the plan, rather than Original Medicare. Most of these plans also include prescription drug coverage.
What is
Medicare Advantage?
Different types of Medicare Advantage Plans
Medicare Advantage Plans include several common types such as:
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Health Maintenance Organization (HMO) Plans
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Preferred Provider Organization (PPO) Plans
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Private Fee-for-Service (PFFS) Plans
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Special Needs Plans (SNPs)
In addition to these, there are some less common Medicare Advantage Plans that may be available:
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HMO Point of Service (HMOPOS) Plans: These are HMO plans that allow you to access certain out-of-network services at a higher cost.
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Medical Savings Account (MSA) Plans: These plans combine a high-deductible health insurance plan with a savings account. Medicare deposits funds into the account (typically less than the deductible), which you can use to cover your health care expenses throughout the year
How do Medicare Advantage Plans work?
Medicare Advantage Plans, also known as “Part C” or “MA Plans,” offer an all-in-one alternative to Original Medicare. These plans are provided by private companies approved by Medicare. When you enroll in a Medicare Advantage Plan, you retain your Medicare coverage, but it is bundled into a single plan that includes Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), and often Medicare Part D (prescription drug coverage).
Common Queries
Guidelines for
Medicare Advantage Plans
Medicare provides a fixed monthly payment to the companies that offer Medicare Advantage Plans, and these companies are required to follow Medicare’s regulations.
Each Medicare Advantage Plan may have varying out-of-pocket costs, as well as different rules for accessing services, such as:
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Whether you need a referral to see a specialist
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Whether you must use doctors, facilities, or suppliers within the plan's network for non-emergency or non-urgent care
These guidelines can change annually.
Costs for
Medicare Advantage Plans
Prescription Drug Coverage in Medicare Advantage Plans
Most Medicare Advantage Plans include prescription drug coverage (Part D). However, you may need to join a separate Medicare Prescription Drug Plan if you're enrolled in certain types of plans that either:
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Cannot offer drug coverage, such as Medicare Medical Savings Account (MSA) plans
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Choose not to offer drug coverage, like some Private Fee-for-Service (PFFS) plans
If both of the following apply, you will be disenrolled from your Medicare Advantage Plan and returned to Original Medicare:
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You are enrolled in a Medicare Advantage HMO or PPO
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You join a separate Medicare Prescription Drug Plan.
Medigap policies, also known as Medicare Supplement Insurance, cannot be used with Medicare Advantage Plans. Medigap is designed to work only with Original Medicare to help cover additional out-of-pocket costs like copayments, coinsurance, and deductibles. If you enroll in a Medicare Advantage Plan, you cannot use a Medigap policy to pay for any costs under that plan.
What if I Have a
Medigap Policy?