Medicare Advantage Plans, also known as “Part C” or “MA Plans,” provide an alternative way to receive your Medicare Part A and Part B benefits. Offered by Medicare-approved private insurers, these plans follow Medicare regulations and often include prescription drug coverage (Part D). In most cases, you must use healthcare providers within the plan’s network. These plans also set an annual cap on out-of-pocket expenses for covered services. Some may offer limited out-of-network coverage for non-emergency care, typically at a higher cost.
Below are the most common types of Medicare Advantage Plans.
Health Maintenance Organization (HMO)
In HMO plans, you typically need to receive care and services from doctors, healthcare providers, and hospitals within the plan’s network, except for:
Emergency care
Urgent care when outside the coverage area
Temporary out-of-area dialysis
HMO Point-of-Service (HMOPOS) plans offer more flexibility, allowing you to access certain out-of-network services at a higher copayment or coinsurance.
Preferred Provider Organization (PPO)
PPO plans include a network of doctors, healthcare providers, and hospitals. You’ll pay lower costs when using in-network providers but can also access out-of-network providers for covered services, typically at a higher cost. The provider must agree to treat you and not have opted out of Medicare for Part A and Part B services. Emergency and urgent care are always covered, no matter where you receive treatment.
Private Fee-for-Service (PFFS) Plans
PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
Special Needs Plans (SNP)
Medicare Special Needs Plans (SNPs) are designed for individuals with specific diseases or conditions. These plans customize benefits, provider networks, and prescription drug coverage to effectively meet 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 may offer additional benefits beyond Original Medicare, such as fitness programs (gym memberships or discounts), as well as vision, hearing, and dental services like routine checkups or cleanings. Some plans also provide extra coverage, including transportation to doctor visits, over-the-counter medications, and wellness services to support your overall health.
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