There are five types of Medicare Advantage plans. When choosing a plan, a person should consider factors such as their specific healthcare needs, network coverage, premiums, and drug coverage.

Medicare Advantage plans are an alternative to Original Medicare plans. People may also refer to Medicare Advantage as Part C.

Medicare Advantage provides the coverage of Part A and Part B and often includes prescription drug coverage (Part D). Plans may also offer coverage for services such as hearing, vision, and dental care.

This article compares types of Medicare Advantage plans. It also discusses what to consider when choosing a plan and where to start looking for plans.

Glossary of Medicare terms

We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:

  • Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
  • Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
  • Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
  • Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
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There are five types of Medicare Advantage plans to choose from:

This section compares the types of Medicare Advantage plans in more detail. However, individual plans will vary depending on several factors, such as which insurance company offers each plan.

HMO

A person may want to consider the following factors about HMO plans:

  • HMOs typically charge a monthly premium in addition to the monthly Part B premium.
  • HMOs typically offer prescription drug coverage. People cannot get a separate Medicare drug plan if they join an HMO that does not offer drug coverage.
  • HMOs usually require a person to receive their care and services from in-network healthcare professionals, except in emergency situations or for out-of-area dialysis. If a person has an HMO Point-of-Service (HMOPOS) plan, they might be able to receive some services out of network for a higher copayment or coinsurance.
  • People enrolled in an HMO usually need to choose a primary care doctor.
  • People enrolled in an HMO need a referral from their doctor to visit a specialist.

PPO

A person may want to consider the following factors about PPO plans:

  • PPOs typically charge a monthly premium in addition to the monthly Part B premium.
  • PPOs typically offer prescription drug coverage. People cannot get a separate Medicare drug plan if they join an PPO that does not offer drug coverage.
  • Each PPO has a network of healthcare professionals that a person can go to. People enrolled in a PPO can also use out-of-network professionals, but the cost is likely to be higher.
  • People enrolled in a PPO do not usually need to choose a primary care doctor.
  • People enrolled in a PPO do not need a referral from their doctor to visit a specialist.

PFFS plan

A person may want to consider the following factors about PFFS plans:

  • PFFS plans typically charge a monthly premium in addition to the monthly Part B premium.
  • PFFS plans typically offer prescription drug coverage. People can get a separate Medicare drug plan if they join a PFFS plan that does not offer prescription drug coverage.
  • PFFS plans allow a person to see any Medicare-approved healthcare professional, as long as the professional accepts the plan’s payment terms and agrees to treat the person. PFFS plans sometimes have a network of healthcare professionals, and people may have to pay more if they use an out-of-network professional.
  • People with PFFS plans do not usually need to choose a primary care doctor.
  • People with PFFS plans do not need a referral from their doctor to visit a specialist.

SNP

A person may want to consider the following factors about SNPs:

  • SNPs typically charge a monthly premium in addition to the monthly Part B premium.
  • All SNPs offer prescription drug coverage.
  • If the SNP is an HMO, a person needs to use in-network healthcare professionals, except in emergency situations or for out-of-area dialysis. However, if the SNP is a PPO, they can use out-of-network professionals.
  • People with SNPs may or may not need to choose a primary care doctor, depending on the individual plan requirements.
  • If the SNP is an HMO, a person needs a referral from their doctor to visit a specialist. If the SNP is a PPO, they do not need a referral.

MSA

A person may want to consider the following factors about MSA plans:

  • MSAs typically do not charge a separate monthly premium, but a person still pays the monthly Part B premium.
  • People with MSAs will need to join a separate Medicare drug plan.
  • MSAs do not usually have a network of healthcare professionals. People with MSAs can use Medicare-approved healthcare professionals for services that Original Medicare covers.
  • People with MSAs do not usually need to choose a primary care doctor.
  • People with MSAs do not need a referral from their doctor to visit a specialist.

Medicare resources

For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.

When deciding which Medicare Advantage plan is best for them, a person may want to consider the following questions:

What are their individual healthcare needs?

For example, SNPs provide benefits and services to people with specific health conditions or certain healthcare needs, as well as those who also have Medicaid. Additionally, people may want to consider:

  • whether they need prescription drug coverage
  • whether they need services such as hearing, vision, and dental care
  • how frequently they need to see specialists and whether they want to request a referral for every specialist appointment
  • whether they already visit certain healthcare professionals regularly and whether those professionals are included in the plan network

How much are the deductibles, coinsurance, copayments, and premiums?

Every person will have a different budget. Some people may want to prioritize plans with lower premiums, whereas others may have more flexibility. People should make sure to check all potential out-of-pocket costs.

What options are available in their area?

Medicare Advantage plan options may vary depending on where a person lives. Some insurance companies may provide coverage only in certain areas.

People may want to take note of the pros and cons of each plan or make a list of nonnegotiables they are looking for in a plan.

A person can start by using the Medicare plan finder to find out which Medicare Advantage plans are available in their area. They may also find this comparison table useful for identifying the differences among types of Medicare Advantage plans.

After comparing plans, people should consider checking the plan details against the provider’s website. Additionally, a person can call the plan provider directly to double-check the details.

There are five types of Medicare Advantage plans that a person may want to consider choosing: HMOs, PPOs, PFFS plans, SNPs, and MSAs.

Factors that people may want to think about when choosing a Medicare Advantage plan include the costs, their individual healthcare needs, and any additional benefits.