{"id":49079,"date":"2022-02-16T16:46:28","date_gmt":"2022-02-16T21:46:28","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=49079"},"modified":"2025-06-13T15:26:52","modified_gmt":"2025-06-13T19:26:52","slug":"what-is-medicare-advantage","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/what-is-medicare-advantage\/","title":{"rendered":"What is Medicare Advantage?"},"content":{"rendered":"

There are two ways to enroll in Medicare coverage: <\/span>Original Medicare and Medicare Advantage<\/span><\/a>. Medicare Advantage is provided by private insurers. It includes the same coverage as Parts A, B, and usually D, plus some extra benefits that Original Medicare doesn\u2019t cover, such as hearing, vision, or dental benefits.<\/span><\/p>\n

What is Medicare Advantage (Part C)?<\/span><\/h2>\n

Medicare Advantage plans, also called Medicare Part C or MA plans, are privately administered health insurance plans that offer Medicare Part A and Medicare Part B benefits. The insurance companies must follow the rules and regulations set by Medicare. The major benefit of MA health plans is that they sometimes come with extra perks.\u00a0<\/span><\/p>\n

What do Medicare Advantage plans cover?\u00a0<\/span><\/h2>\n

\u201cMedicare Advantage is a [privately administered] alternative to Original Medicare that bundles the parts of Original Medicare along with additional benefits,\u201d explains<\/span> Kate Ashford<\/span><\/a>, Medicare specialist at NerdWallet. \u201cIt includes Part A and Part B and often Part D drug coverage, plus some extra benefits such as cost help with dental and vision care.\u201d<\/span><\/p>\n

Who qualifies?<\/span><\/h2>\n

You are eligible for an MA plan as long as you are<\/span> eligible for Medicare<\/span><\/a>, have Parts A and B, and live in that plan\u2019s service area. There is no income limit for those who want to enroll in Medicare Advantage plans. There are even some special needs plans for those with a limited income.<\/span><\/p>\n

6 types of Medicare Advantage plans<\/span><\/h2>\n

There are six types of Medicare Advantage plans. The most popular of these plans are health maintenance organization (HMO) plans and preferred provider organization (PPO) plans. Here are the six Medicare Part C plans offered from most popular to least popular.<\/span><\/p>\n

1. HMO plans<\/span><\/h3>\n

HMO plans<\/span><\/a> generally only cover healthcare services that are done within a specific network of doctors and hospitals. If you choose to use someone out-of-network, you will likely have to pay in full without the help of your plan. While you have fewer options for obtaining medical services with an HMO plan, services are typically cheaper overall than those offered with PPO plans.\u00a0<\/span><\/p>\n

RELATED:<\/b> HMO vs. PPO plans<\/b><\/a><\/p>\n

2. PPO plans<\/span><\/h3>\n

With<\/span> PPO plans<\/span><\/a>, there is still a network of providers that you can visit for lower costs. However, if you see an out-of-network provider, insurance will still cover it, but it will likely come at higher costs to you.<\/span><\/p>\n

3. Private fee-for-service plans<\/span><\/h3>\n

Some fee-for-service plans, or PFFS plan,s will have a network. If the plan has no network, you can use any provider that accepts Medicare. These plans are not very popular, as it is possible that healthcare providers will not agree to your plan’s reimbursement rates and refuse your service if they\u2019re not in-network. As another downside, these plans typically do not include a prescription drug plan.\u00a0<\/span><\/p>\n

RELATED:<\/b> What does \u2018out-of-network\u2019 mean?<\/b><\/a><\/p>\n

4. Special needs plans<\/span><\/h3>\n

Special needs plans, or SNPS, are often recommended for individuals with chronic health conditions. These plans are customized to their specific needs. SNPS are also popular among individuals who have both<\/span> Medicare and Medicaid<\/span><\/a> or those living in nursing homes.<\/span><\/p>\n

RELATED:<\/b> Does Medicare cover pre-existing conditions?<\/b><\/a><\/p>\n

5. Medical savings accounts<\/span><\/h3>\n

Medical savings accounts (MSAs) are not common, but a few select Medicare Advantage plans use this method. In MSAs, you\u2019ll have a<\/span> high deductible<\/span><\/a> and a<\/span> health savings account<\/span><\/a> where money is deposited monthly. These plans typically do not include any prescription coverage.<\/span><\/p>\n

6. HMO point-of-service<\/span><\/h3>\n

These plans, as the HMO name suggests, have a network of providers. However, with HMO point-of-service plans, some out-of-network costs will be covered at a higher rate. You will have two deductibles for both your in-network and out-of-network costs.<\/span><\/p>\n\n\n\n\n\n\n\n\n\n
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Original Medicare vs. Medicare Advantage<\/span><\/h2>\n<\/th>\n<\/tr>\n<\/thead>\n

<\/td>\nOriginal Medicare<\/b><\/td>\nMedicare Advantage<\/b><\/td>\n<\/tr>\n
Coverage*<\/b><\/td>\n\n
    \n
  • Part A: Inpatient hospital insurance\u00a0<\/span><\/li>\n
  • Part B: Outpatient medical insurance, including doctor\u2019s visits, wellness visits, urgent care visits, and medical tests<\/span><\/li>\n
  • Part D: A Medicare prescription drug plan<\/span><\/li>\n<\/ul>\n<\/td>\n
\n
    \n
  • Includes Medicare Part A and Part B coverage\u00a0<\/span><\/li>\n
  • Many plans will also cover Medicare Part D (prescription drugs)<\/span><\/li>\n
  • Plans may have additional perks, including transportation to medical appointments as well as vision, hearing, and dental services<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Eligibility<\/b><\/td>\nPeople 65 and older, as well as younger people with disabilities and those with end-stage renal disease (ESRD) or ALS.<\/span><\/td>\nAnyone who is eligible for Original Medicare and has Parts A and B is eligible for MA. However, certain plans may also only be available based on your location.<\/span><\/td>\n<\/tr>\n
Provider<\/b><\/td>\nFederal government<\/span><\/td>\nPrivate insurance\u00a0<\/span><\/td>\n<\/tr>\n
Costs<\/b><\/a><\/td>\nPart A is premium-free for most individuals with a deductible. Coinsurance applies to covered inpatient stays longer than 60 days.<\/span><\/p>\n

Part B has a monthly premium, deductible, and coinsurance.<\/span><\/p>\n

Part D has a monthly base premium, a variable deductible, and coinsurance\/copays until an out-of-pocket threshold is met.<\/span><\/td>\n

MA premiums, copayments, and deductibles vary.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

* This is a summary of coverage. There are other benefits not listed here.<\/span><\/i><\/p>\n

Other tips for choosing between Original Medicare and Medicare Advantage:<\/span><\/h3>\n