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 are Medicare Advantage plans?

Medicare Advantage plans, known as Part C, are sometimes referred to as 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 Medicare Advantage plans also offer benefits that aren’t available with Original Medicare, such as routine vision, hearing and dental care.

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.

Comparing the different types of Medicare Advantage plans

The most common Medicare Advantage plans are:

  • Health maintenance organization (HMO) plans
    • HMO plans may sometimes offer lower premiums than other plans, but you must usually stay within your plan’s network for care and services.
  • Preferred provider organization (PPO) plans
    • PPO plans may allow you to go out-of-network for care, but you will usually pay less if you stay within the plan’s network.
  • Private fee-for-service (PFFS) plans
    • PFFS plans are offered through private insurance companies. You will pay health care providers directly for services based on an amount that your plan determines.
  • Special needs plans (SNPs)*
    • SNPs are limited to people with specific conditions. These plans are tailored to meet the specific needs of members within the plan.

Compare common Medicare Advantage plans side by side

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

What to consider in a Medicare Advantage plan?

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

Coverage for prescription drugs (Part D)

Most Medicare Advantage plans offer prescription drug coverage, and all SNPs* must cover prescription drugs.1

Referral requirements for specialist care

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.2

Contracted network of doctors and hospitals

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 network

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.

Star ratings

Each year, the Centers for Medicare & Medicaid Services (CMS) releases the Medicare Advantage and Medicare Part D Star Ratings. These ratings go up to 5 and measure the quality of Part C and Part D plans based on up to 38 performance measures, including customer service, care coordination and availability of certain preventive care screenings.3

How to enroll in a Medicare Advantage plan

Since Medicare Advantage plans are offered through private insurance companies, the costs may vary from plan to plan. The projected average premium for a Medicare Advantage plan in 2023 is $18 per month, but there are other costs to consider, including co-pays and deductibles.4 To get a comparison of costs between different Medicare Advantage and Medicare Part D plans, use Medicare’s plan finder.

How to enroll in a Medicare Advantage plan

Your first chance to sign up for Medicare Advantage is during your Medicare Initial Enrollment Period (IEP). The IEP for Medicare starts 3 months before the month you turn 65 and ends 3 months after.

If you are already enrolled in Medicare Advantage, you can switch plans during the Medicare Advantage Open Enrollment Period (OEP). The Medicare Advantage OEP runs from Jan. 1 to March 31, or the annual enrollment period for Medicare.

If you have Original Medicare and want to enroll in Medicare Advantage for the first time, you can choose a Medicare Advantage plan during Medicare’s Annual Enrollment Period (AEP). Medicare’s AEP runs from Oct. 15 to Dec. 7.

Find the best Medicare Advantage plan for you

Everyone has different health needs. Be sure to look up your plan’s network, costs and its list of covered drugs before making your decision. By taking the time to research and compare Medicare Advantage plans, you can find the one that benefits you the most.

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

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Sources:

  1. “Understanding Medicare Advantage Plans,” medicare.gov, last accessed September 16, 2022, https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf, PDF.
  2. “Understanding Medicare Advantage Plans.”
  3. “Fact Sheet - 2022 Part C and D Star Ratings,” Centers for Medicare & Medicaid Services, last accessed September 16, 2022, https://www.cms.gov/files/document/2022-star-ratings-fact-sheet1082021.pdf, PDF.
  4. “Biden-Harris Administration Announces Lower Premiums for Medicare Advantage and Prescription Drug Plans in 2023,” Centers for Medicare & Medicaid Services, last accessed October 5, 2022, https://www.cms.gov/newsroom/press-releases/biden-harris-administration-announces-lower-premiums-medicare-advantage-and-prescription-drug-plans.