Learn about your Medicare Advantage Plan options.
Medicare Advantage (MA) Plans are the alternative way for you to get your traditional Medicare benefits. Also known as Medicare Part C, Medicare Advantage Plans bundle your Medicare Part A, Part B, and usually, Part D prescription drug benefits into one plan. MA plans offer additional coverage for non Medicare-covered services, such as dental, vision, and hearing.
Medicare Advantage Plans are offered by Medicare-approved private insurance companies and are growing in popularity. In 2021, 42% of the Medicare population are enrolled in a Medicare Advantage Plan. On average, a Medicare beneficiary has access to 39 Medicare Advantage Plans xTrusted Source Kaiser Family Foundation (KFF) Non-profit organization focusing on national health issues, as well as the U.S. role in global health policy. Non-profit organization in 2022, and more than nine out of ten people can choose a zero-premium plan that includes prescription drug coverage.
There are different types of Medicare Advantage Plans from a variety of insurers, but most include cost savings through a provider networks. You can choose the best plan for you based on your budget and how you prefer to access your healthcare. Costs and coverage vary depending on where you live. You can search for plans on Medicare’s website. Read below to learn more about your options.
There are four main types of Medicare Advantage Plans: HMOs, PPOs, PFFS, and SNPs. Most plans include extra benefits that Medicare doesn’t cover, such as dental, hearing, vision, and fitness club memberships. HMOs and PPOs are the most popular plan types and are widely available from most insurers.
Here are the important points about each type of plan:
|Health Maintenance Organizations (HMOs)
HMOs typically require that you receive all services from in network providers:
|Preferred Provider Organizations (PPOs)
PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
|Private Fee-for-Service (PFFS)
PFFS plans don’t require a primary care physician or referrals for specialists:
|Special Needs Plans (SNPs)
SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
All plans, except SNPs, require you to pay your monthly Part B premium ($170.10 in 2022). You will likely have access to at least one zero-premium plan with drug coverage in your area. In addition to Part A and B coverage, many plans include drug coverage and extra benefits, such as hearing, dental, and vision. See how the Medicare Advantage Plan types compare:
|HMOs||HMOs typically require that you receive all services from in network providers:
|PPOs||PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
|PFFS Plans||PFFS plans don’t require a primary care physician or referrals for specialists:
|SNPs||SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
To choose a plan, determine your personal needs and preferences and look at how plans available in your area can effectively meet them. When evaluating plans, ask the following kinds of questions:
There is no one correct answer when choosing a Medicare Advantage plan. What is best for one senior isn’t necessarily the right choice for another. Enrolling in a Medicare Advantage plan needs to be a personal decision based on individual health and budget requirements.
Every region of the country has access to a different array of Medicare Advantage plans. To find locally available plans, start by going to Medicare’s website, Medicare.gov. Click on the “Find Plans” button in the middle of the screen to search for Medicare Part D and Medicare Advantage plans.
You can create an account before evaluating plan options or browse as a guest. Each plan lists out details, including costs for premiums and covered services, in-network hospitals, pharmacies, and doctors. A star quality rating assigned by Medicare is also visible to help you make an informed decision about how well a plan meets consumers needs. Seniors who are prepared to make a plan choice can begin the enrollment process online.
Anyone who is eligible for or already enrolled in Medicare Parts A and B is eligible for Medicare Advantage. You must enroll in one of the designated time periods, either when first eligible, during open enrollment, or a special enrollment period.
Choosing the right Medicare Advantage is an important decision that affects finances and health care. By understanding the available plan types and coverage options, you can move forward with Medicare Advantage with confidence.
Roseann Birch has worked in the insurance industry for more than 35 years. In 2006, she moved to selling insurance and, by 2009, Birch made Medicare her area of expertise after observing the struggles of older adults to understand Medicare. Although many adults age 65 and older are eligible for Medicare, nearly just as many don’t understand how it works.
Birch has learned the ins and outs of Medicare and its variations and supplements to help beneficiaries and their families understand benefits. She finds there is often misinformation and makes it her mission to clear up the confusion so that everyone can enjoy the full extent of Medicare benefits.