Congress added Medicare Advantage plans to give Medicare participants more choices about how they receive their health care. That's why you'll find different kinds of plans in this category.
Medicare Advantage plans are all offered by private companies that have been approved by Medicare. To encourage competition, Medicare gives the private companies flexibility in setting the terms of each plan. That means you'll find considerable variation among plans as you shop.
Overview
In four kinds of Medicare Advantage plans—Health Maintenance Organization (HMO), Point of Service (POS), Preferred Provider (PPO) plans and Special Needs Plans (SNP)—your care is "coordinated." That means the plan may coordinate your coverage through a primary care physician who manages the care you receive from specialists and hospitals. You may have to choose specific doctors and hospitals. This is different from Original Medicare (Part A and Part B), where you can visit any doctor or hospital that accepts payment from Medicare.
The other two types of plans—Private Fee-For-Service (PFFS) plans and Medical Savings Account (MSA) plans—do not use coordinated care. In these plans, you can get care from any provider who is willing to accept the terms, conditions and payment rates each time they furnish covered services for you.
Medicare Advantage comparison: Choosing a Medicare Advantage plan
Many people who choose a Medicare Advantage plan choose a
coordinated care plan—an
HMO, POS, PPO or
SNP. If you're interested in a Medicare Advantage plan, you'll need to do some homework.
Look at the additional premium (if any) you'd pay for any plans you are considering. It's "additional" because you need to have both Medicare Parts A and B to enroll in a Medicare Advantage plan, and you pay a Medicare premium for Part B. You pay this premium to Medicare, whether you get your Medicare benefits through Original Medicare or through a Medicare Advantage plan. With many Medicare Advantage plans, you will not be charged any premium beyond the Part B premium you pay to Medicare.
It's a good idea to estimate the total cost sharing (including premiums, deductibles, copays and coinsurance) for the services you think you or your loved one may need throughout the year. Find a Medicare Advantage plan where the cap, or maximum on your out-of-pocket spending, fits your budget. Also, consider whether a plan's
network (if it has one) gives you access to the doctors you want to see.
If you want both prescription drug coverage and a Medicare Advantage
coordinated care plan like an
HMO, POS or PPO plan, choose one with prescription drug coverage built in.
Important: You can't combine a standalone prescription drug plan with a coordinated care Medicare Advantage plan. You can, however, combine a standalone prescription drug plan with a PFFS or MSA Medicare Advantage plan, or with Original Medicare.
Shopping for a Medicare Advantage plan
Start shopping by finding out what's available in your area. You can find a list of plans at Medicare.gov, by calling the Medicare Helpline, or by contacting Medicare Made Clear at 1-877-619-5582, TTY 711. Representatives are available 8 a.m. to 8 p.m. local time, 7 days a week.
Medicare's list of plans includes contact information for each plan. You can call each plan and ask for more information.
You can also get plan information from your State Health Insurance Assistance Program (SHIP).
Important: If you have end-stage renal disease, there are some special rules for you. Contact the Medicare Helpline or your state Medical Assistance program for more information.