Get more from a Medicare Advantage plan.
Medicare Advantage plans, also known as Part C, offer a bundled approach and an alternative to Original Medicare. They include Parts A and B. In addition, they may offer additional services such as prescription drug, dental and vision coverage.
Provided by insurance companies, Medicare Advantage plans are similar to HMO and PPO plans with a network of doctors, specialists and hospitals.
Please enter your zip code to compare plans in your area.
Medicare Advantage Simplified
Medicare Advantage (Part C) is an alternative to Original Medicare.
It includes Parts A and B, and often Part D coverage.
As you research Medicare Advantage plans, here are some things to consider before joining a plan:
- Most plans include drug coverage, but it’s important to know how much you’ll pay for the prescription drugs you need.
- There are HMO and PPO options, so you may be required to see doctors or specialists in-network.
- Find out if your doctor accepts the plan you’re considering.
- Some plans also include extra benefits, such as vision, dental or wellness benefits.
Types of Medicare Advantage Plans
Generally speaking, there are three types of plans.
Medicare Advantage HMO
These plans often offer the lowest monthly premiums but are also the most restrictive. Most offerings will be centered around your primary care physician (PCP). That physician will be needed as a referral to get access to any specialists in the network.
Medicare Advantage PPO
These plans are more flexible, allowing you to see any physician in the network, usually without a referral. This increased choice comes with a higher price tag.
Medicare Private Fee-for-Service or PFFS
These plans have a small network or no network at all. You can see any doctor who will agree to your plan’s terms and conditions. This requires that you get providers to agree to the plan’s terms and conditions before treatment.
Additional Benefits and Costs
Medicare Advantage Benefits
These benefits vary by plan but may include:
- Gym memberships
- $0/month premium plans and $0 deductible plans may be available in your area
- Prescription drug coverage
- Routine vision, hearing and dental
Medicare Advantage Plan Costs
- Many of these plans are surprisingly affordable. Just remember, choosing a Medicare Advantage plan requires you to continue paying Part B premiums. Paying both premiums can be a bit daunting, but many Medicare Advantage plans have very low monthly premiums—some even have $0 monthly costs.
- The trick to keeping costs down is to stay within the plan’s network. Using any provider outside of your network can be very costly.
Compare Medicare Advantage (MA) Options
HMO
Local PPO
Regional PPO
PFFS
Network Size
One or more counties
One or more counties
Larger network area, such as statewide
Varies
Plan Availability
Most common MA plan
Most common PPO plan
Least common PPO plan
Only available in areas with less than 2 MA plans
Specified PCP
Yes
Usually, no
Usually, no
Usually, no
Referrals Required
Usually, yes
No
No
No
Maximum
Out-of-pocket*
Yes
in-network only no out-of-network
Yes
in-network only no out-of-network
Yes
in-network only no out-of-network
Yes
in-network only no out-of-network
*The most you have to pay for covered services in a plan year.
Compare Medicare Advantage (MA) Options |
||||
| HMO | Local PPO | Regional PPO | PFFS | |
|---|---|---|---|---|
| Network Size | One or more counties | One or more counties | Larger network area, such as statewide | Varies |
| Plan Availability | Most common MA plan | Most common PPO plan | Least common PPO plan | Only available in areas with less than 2 MA plans |
| Specified PCP | Yes | Usually, no | Usually, no | Usually, no |
| Referrals Required | Usually, yes | No | No | No |
| Maximum Out-of-pocket* | Yes in-network only no out-of-network |
Yes in-network only no out-of-network |
Yes in-network only no out-of-network |
Yes in-network only no out-of-network |
*The most you have to pay for covered services in a plan year. |
||||
The best way to get started
Now that you have a general working knowledge of Medicare Advantage, let’s get shopping for your best plan. Don’t worry, we’re here to help you every step of the way. Just click the link below and we can continue the journey together.