What are Medicare Advantage Plans (Part C)?

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare.  Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.  If you join a Medicare Advantage Plan, you still have Medicare.  You’ll get your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare.

*Source:Centers for Medicare & Medicaid Services, “Medicare & You 2014”, p.72


There are different types of Medicare Advantage Plans:

Health Maintenance Organization (HMO) PlansIn most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network except in an emergency.  You may also need to get a referral from your primary care doctor.

Preferred Provider Organization (PPO) PlansIn a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network.  You usually pay more if you use doctors, hospitals, and providers outside of the network.

Private Fee-for-Service (PFFS) Plans—PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they agree to accept the conditions and terms of payment from the “Plan”.  The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Special Needs Plans (SNP)—SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, who live in a nursing home, or have certain chronic medical conditions.

HMO-Point-of-Service (HMO-POS) PlansThese are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.

Medical Savings Account (MSA) PlansThese are plans that combine a high deductible health plan with a bank account.  Medicare deposits money into the account (usually less than the deductible).  You can use the money to pay for your health care services during the year.


*Source: Centers for Medicare & Medicaid Services, “Medicare & You 2014”, p.73