People With Medicare

Medicare Advantage

What are Medicare Advantage plans?


You can join a Medicare Advantage plan to get Medicare Part A and Part B coverage. Some of these plans also give you Medicare drug coverage. These health plans have contracts with Medicare. When you join one, you get your Medicare-covered health care services through the private plan.

There are different types of Medicare health plans, such as these:
  • Health Maintenance Organizations (HMOs)
  • Preferred Provider Organizations (PPOs)
  • Private Fee-for-Service plans (PFFS)
  • Special Needs Plans (SNPs)
  • Medical Savings Accounts

Medicare Advantage plans must cover all the same things as Medicare Part A and B. They may offer extras. They may charge different amounts than you would pay through Original Medicare. Medicare Advantage plans may also cover prescription drugs. If they do, you cannot buy a separate Medicare prescription drug plan.

With Medicare Advantage plans, you generally must use certain providers. These are doctors, hospitals, drugstores, and other health care providers that the plans have contracts with. These are called in-network providers. If you use providers outside your plan's network, it may cost you more money. It also may mean you get no Medicare coverage at all for that service.

Before you join a Medicare Advantage plan, make sure your doctor and drugstore are in the plan's network.

Medicare Advantage plans also may cover services that Original Medicare does not pay for. Examples are eye exams or a pair of eyeglasses each year, or a hearing exam.

You must have Medicare Parts A and B to join a Medicare Advantage plan. You pay your usual Part B premium plus any additional premium that the plan may charge.

    Note: The Part B premium usually comes out of your Social Security check automatically.

Be sure you understand the rules of Medicare Advantage plans before you enroll.

You can find and compare Medicare health plans online. You also can get personal help.

Medicare Advantage Plan Types


There are several different types of Medicare Advantage plans. These are the most common:

Some General Rules of the Plan

Types of Plans

Health Maintenance Organizations (HMOs)

 If you do not get your care from a provider the HMO approves, called an in-network provider, Medicare will not cover it.

You usually need a referral from your primary care provider to see a specialist.

Preferred Provider Organizations (PPOs)

 You can get care from a Medicare provider out of your network. But you will pay more for out-of-network care.

You will not need a primary care doctor.

Private Fee-for-Service plans (PFFS)

There is no network of providers.


You can see any Medicare provider who agrees to the plan's terms and payments.


Providers can decide on a case-by-case and visit-by-visit basis whether or not to see you.

Special Needs Plans (SNPs)

 These are PPOs or HMOs that only admit people with Medicare who:
  • Have certain serious chronic medical conditions, or
  • People who have Medicaid and Medicare, or
  • People who live:
    • In certain nursing homes or
    • At home but have high care needs and could qualify for a nursing home.

Medical Savings Accounts (MSAs)

 You must pay a very high deductible before the plan covers any benefits. A health savings account is linked to the plan.



Medicare puts money in the savings account each year, but the amount is less than your annual deductible.

If you need help comparing your options, get personal help.

NEXT: How do I fill gaps in coverage?

Information on this web site was compiled from approved materials of the Centers for Medicare and Medicaid Services.