What You Should Know
  • More than 26,000,000 seniors are enrolled in Medicare Advantage plans in 2021. That’s 42% of the Medicare population.
  • To choose a plan that is best for you, consider what is most important to you in terms of costs and how you prefer to access your healthcare.
  • Every region of the country has access to a different array of Medicare Advantage plans.
  • Anyone who is eligible for or already enrolled in Medicare Parts A and B is eligible for Medicare Advantage.

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 Go to Source 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.

What Are the Different Types of Medicare Advantage Plans?

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:

  • You must have a primary care physician (PCP), referrals for specialists, and prior authorizations for treatments and some prescriptions.
  • Drug coverage usually is included. You aren’t able to purchase standalone drug coverage.
  • Lower costs if you stay in network.
  • A point-of-service option (HMO-POS) allows you to receive out of network care for some services.
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.

  • You don’t need to choose a primary care doctor or referrals for specialists.
  • Drug coverage is usually included.
  • You aren’t able to purchase stand-alone drug coverage.
  • Higher premium and out-of-network costs.
Private Fee-for-Service (PFFS)

PFFS plans don’t require a primary care physician or referrals for specialists:

  • You can go to any Medicare-approved health care provider or facility that accepts the plan’s payment terms and agrees to treat you.
  • May include drug coverage, or you can purchase a standalone drug plan.
  • Higher cost if you choose a provider that doesn’t agree to the plan’s terms.
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:

  • You need a PCP and referrals to specialists.
  • Drug coverage is always included.
  • If you’re eligible, you can join an SNP at any time.
  • There are three kinds of SNPs:
    • I-SNP for people who live in institutions or need nursing care at home
    • C-SNP for people with severe or disabling chronic illness
    • D-SNP for people who are dual eligible for Medicare and Medicaid.

Compare your Medicare Advantage options

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:

Types of Medicare Advantage Plans
HMOs HMOs typically require that you receive all services from in network providers:

  • You must have a primary care physician (PCP), referrals for specialists, and prior authorizations for treatments and some prescriptions.
  • Drug coverage usually is included. You aren’t able to purchase standalone drug coverage.
  • Lower costs if you stay in network.
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.

  • You don’t need to choose a primary care doctor or referrals for specialists.
  • Drug coverage is usually included.
  • You aren’t able to purchase stand-alone drug coverage.
  • Higher premium and out-of-network costs.
PFFS Plans PFFS plans don’t require a primary care physician or referrals for specialists:

  • You can go to any Medicare-approved health care provider or facility that accepts the plan’s payment terms and agrees to treat you.
  • May include drug coverage, or you can purchase a standalone drug plan.
  • Higher cost if you choose a provider that doesn’t agree to the plan’s terms.
SNPs SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:

  • You need a PCP and referrals to specialists.
  • Drug coverage is always included.
  • If you’re eligible, you can join an SNP at any time.

How to Choose a Medicare Advantage Plan

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:

  • What are my medication needs? Do I need a plan with comprehensive medication coverage, or is purchasing a separate prescription drug plan more beneficial? Remember, if you join an HMO or PPO, you cannot purchase a separate drug coverage plan.
  • Are my current preferred doctors, specialists, and pharmacies in network?
  • How much money can I afford to spend on premiums each month? Is a more expensive plan with minimal deductibles, coinsurance, or copays a better value?
  • Will my travel plans affect my coverage needs?
  • Do I need any plan extras, such as vision, dental, or hearing coverage?
  • Am I eligible for a Special Needs Plan?

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.

How Do I Find Medicare Advantage Plans Near Me?

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.

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Medicare consultant

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.

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