Medicare Advantage plans are available throughout the United States. However, plan and coverage options differ by area and state.
Medicare Advantage (Part C) is an alternative to Original Medicare (Parts A and B). Private insurance companies provide these plans.
Medicare Advantage plans combine the coverage of Parts A and B, while most also offer prescription drug plans (Part D). Many plans also offer extra benefits that Original Medicare does not cover, such as vision and dental.
This article explains how Medicare Advantage plans vary from state to state. It also discusses the types of plans and gives tips for selecting the best plan.
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.
Medicare-approved private health insurance companies provide Medicare Advantage plans. However, these companies need to follow specific rules that Medicare sets out.
Medicare Advantage plans also need to provide the same coverage as Original Medicare. Most of these plans also include prescription drug plans. They may also offer coverage of additional benefits that Original Medicare does not cover. These may include vision, hearing, dental, and fitness plans.
While insurance companies have to follow the rules that Medicare stipulates, coverage, cost, and plan types may vary by state and area.
Some Medicare Advantage plans offer coverage from state to state. However, other plans may not provide coverage outside their defined area.
Certain plans may also limit the amount of time a person can spend outside of the defined area while still receiving coverage.
According to the Kaiser Family Foundation (KFF), the average Medicare beneficiary has access to 43 Medicare Advantage plans in 2024.
Learn more about Medicare Advantage.
There are various types of Medicare Advantage plans people can choose from. Each type may not be available in every area.
Individuals can search for plans available in their area using the Medicare online tool.
| Plan Type | Monthly premium | Drug coverage | In-network doctors | Primary care physician (PCP) | Referrals |
|---|---|---|---|---|---|
| Health Maintenance Organization (HMO) | These plans typically charge a monthly premium in addition to the Part B premium. | Most HMO plans offer drug coverage. | Most care must come from in-network providers. | Individuals typically need to choose a PCP. | Individuals require a referral from a doctor to consult a specialist. |
| Preferred Provider Organization (PPO) | Most of these plans charge a monthly premium in addition to the Part B premium. | PPO plans usually include prescription drug coverage. | Each plan has a list of network providers. Individuals can go out-of-network, but costs may be higher. | Individuals do not have to choose a PCP. | Referrals do not need to consult a specialist. |
| Private Fee-for-Service (PFFS) | PFFS plans typically charge a monthly premium in addition to the Part B premium. | These plans usually include drug coverage. | Individuals can go to any Medicare-approved provider. | Individuals do not need to choose a PCP. | Referrals do not need to consult a specialist. |
| Medicare Savings Account (MSA) | There is no additional monthly premium to the Part B premium. | MSAs do not offer drug coverage. Individuals can join a separate drug plan. | Individuals can go to any Medicare-approved provider. | Individuals do not need to choose a PCP. | Referrals do not need to consult a specialist. |
| Special Needs Plan (SNP) | Most SNPs charge a monthly premium in addition to the Part B premium. | All SNPs need to offer prescription drug coverage plans (Part D). | If the type of plan requires an in-network provider, then an individual must abide by that. | Some SNPs may require individuals to choose a PCP. | Some SNPs may require referrals to speak with a specialist. |
There are certain things a person may want to consider when choosing a Medicare Advantage plan.
- Consider health needs: An individual can consider all their current and potential health needs. They need to check that coverage, doctors, and hospitals can cover their needs.
- Consider income: Comparing a person’s income to monthly premiums, copays, and coinsurance payments is important when choosing a plan.
- Find the right plan: Utilizing the Medicare plan finder tool can help a person compare plans available in their area.
- Look for cost savings options: Individuals may qualify for help with costs, including Extra Help and Medicaid.
Read more about choosing a Medicare Advantage plan.
There are certain enrollment periods when people can enroll in Medicare Advantage plans.
- Initial enrollment period (IEP): This begins 3 months before a person’s 65th birthday and extends for 3 months after their birth month. During this period, individuals can join any Medicare plan.
- Open Enrollment Period (OEP): This period runs from October 15 to December 7 each year. During this time, people can join, drop, or switch Medicare plans. They can also change from Original Medicare to Medicare Advantage.
- Medicare Advantage Open Enrollment Period: This period is for those who already have a Medicare Advantage plan. The period runs from January 1 to March 31 each year. Individuals can switch their Medicare Advantage plan or change back to Original Medicare during this time.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare Advantage plans are available in all 50 states and Washington D.C. Medicare-approved private insurance companies provide these plans.
These insurance companies must follow certain rules that Medicare stipulate. However, the type of plans, coverage, and cost may vary by state and area.
Individuals can compare plans available in their area on the Medicare website.