The benefits of Medicare Advantage plans can make them a great alternative to Original Medicare. However, it’s important to understand the differences of each plan before making a decision.

To help you choose what’s best for your needs, let's take a look at the types of Medicare Advantage plans and how they compare.

What is Original Medicare?

The term Original Medicare refers to Medicare Part A and Part B. Part A helps cover the cost of hospital-related care, including inpatient services, lab tests and surgery. Part B is the medical insurance component of Medicare, which helps cover doctor visits, outpatient care and certain preventive services. Both Part A and Part B are administered by the federal government.

What are Medicare Advantage plans?

Medicare Advantage plans, known as Part C, are all-in-one packages for Original Medicare services. They cover Part A and Part B, and most include Part D (prescription drugs) as well. Some plans also offer benefits that aren’t available with Original Medicare, such as vision, hearing and dental care.

The most common Medicare Advantage plans are:

  • Health maintenance organization (HMO) plans
  • Preferred provider organization (PPO) plans
  • Private fee-for-service (PFFS) plans
  • Special needs plans (SNPs)*

*SNPs can be any type of MA plan such as a HMO or PPO

The differences between Medicare Advantage plans

To help you compare Medicare Advantage plans and see their differences, here are some important features to consider:

Coverage for prescription drugs (Part D)1

Most plans offer prescription drug coverage, and all SNPs* must cover prescription drugs.

Referral requirements for specialist care2

Most HMO plans require you to get a referral from your primary care physician for specialist care, while PPO plans typically do not. Some PFFS plans and SNPs* require a referral.

Contracted network of doctors and hospitals3

All Medicare Advantage plans have a contracted network of doctors and hospitals that work in coordination to service your individual healthcare needs.

Ability to use doctors or hospitals outside of network4

HMO plans generally require you to use doctors or hospitals in your network. PPO plans allow you to go outside of your network, but the cost may increase. PFFS plans let you go outside of your network if the doctor or hospital accepts the payment terms and agrees to treat you, and SNPs* generally require you to stay in your network.

Compare common Medicare Advantage plans side by side

Plan feature HMO PPO PFFS SNP* Coverage for prescription drugs (Part D)5 Usually Usually Usually Yes Referral requirements for specialist care6 Yes No Maybe Maybe Contracted network of doctors and hospitals7 Yes Yes Yes Yes Ability to use any doctors or hospitals outside of network8 Maybe Yes Yes No

The choice is yours

Everyone has different health needs. By taking the time to research and compare Medicare Advantage plans, you can find the one that benefits you the most.

Sources

  1. “Understanding Medicare Advantage Plans,” medicare.gov, last accessed June 2020, https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf, opens new window.
  2. “Understanding Medicare Advantage Plans.”
  3. “Understanding Medicare Advantage Plans.”
  4. “Understanding Medicare Advantage Plans.”
  5. “Understanding Medicare Advantage Plans.”
  6. “Understanding Medicare Advantage Plans.”
  7. “Understanding Medicare Advantage Plans.”
  8. “Understanding Medicare Advantage Plans.”

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