HMO
Health Maintenance Organization
Usually uses a defined provider network and may require a primary care doctor or referrals for certain specialist care.
Medicare Part C
Medicare Advantage, explained simply
Medicare Advantage is another way to receive your Part A and Part B benefits through a private plan approved by Medicare.
Part C basics
How Medicare Advantage relates to Parts A and B
You still have Medicare, but the plan manages how you receive your covered services.
To join a Medicare Advantage plan, you must be enrolled in Part A and Part B. The private plan then provides your Part A and Part B benefits and may set rules for providers, referrals, and covered services.
Many plans include prescription drug coverage and may offer additional benefits. Plan availability, networks, benefits, and costs vary by location and can change each year.
Common plan types
Networks and plan rules can work differently
Start by understanding how each type may affect your doctors, referrals, and costs.
PPO
Preferred Provider Organization
Usually offers more provider flexibility, but care outside the plan network may cost more.
SNP
Special Needs Plan
Designed for people who meet specific health, coverage, or living situation requirements.
Other options
Additional plan structures
Some areas may offer other plan types, including Private Fee for Service or Medical Savings Account plans.
Coverage and benefits
What a Medicare Advantage plan may include
Every plan must provide the Part A and Part B benefits Medicare requires. Additional benefits and plan rules differ.
Core and possible added coverage
- Part A and Part B covered services
- Emergency and urgently needed care
- Prescription drug coverage in many plans
- Possible dental, vision, or hearing benefits
- Possible wellness, transportation, or other added benefits
Rules and limitations to review
- Provider networks and service areas
- Referral or prior approval requirements
- Drug formularies and pharmacy networks
- Copayments, coinsurance, and deductibles
- Limits and eligibility rules for added benefits
Benefits are not the same in every plan. Review the plan documents for your location before enrolling.
Before you compare
Three Medicare Advantage basics
Costs, eligibility, and availability can change from one plan or location to another.
Costs
Look beyond the monthly premium
You usually continue paying your Part B premium. The plan may also have premiums, deductibles, copayments, coinsurance, and an annual limit on covered medical costs.
Eligibility
You need Part A and Part B
You must be enrolled in both parts and meet the plan requirements to join.
Service area
Your ZIP code matters
Plans are offered in defined service areas. Moving may change the plans available to you or create a chance to choose new coverage.
Enrollment and changes
Choose the right time and review the details
The enrollment period available to you depends on whether you are new to Medicare, already enrolled, or experiencing a qualifying life event.
- 1
Confirm your enrollment period
You may be able to join during your Initial Enrollment Period, an annual Medicare enrollment period, or a Special Enrollment Period.
- 2
Compare plans in your area
Check your doctors, prescriptions, pharmacy, total costs, travel needs, and coverage priorities.
- 3
Enroll and review your plan materials
After enrollment, use the plan membership card and review the plan rules before receiving care or filling prescriptions.
Compare your coverage paths
Medicare Advantage and Original Medicare
Both paths provide Part A and Part B benefits, but they organize coverage differently.
| Feature | Medicare Advantage | Original Medicare |
|---|---|---|
| How coverage is provided | Through a private plan approved by Medicare | Directly through the federal Medicare program |
| Provider access | Often uses a plan network and may have referral or approval rules | Generally allows any provider in the United States that accepts Medicare |
| Prescription coverage | Included in many plans, but not all | Usually added through a separate Part D plan |
| Additional benefits | May include benefits Original Medicare does not cover | Does not include most routine dental, vision, or hearing care |
| Annual medical spending limit | Includes a plan limit for covered Part A and Part B services | Does not include an annual out of pocket limit by itself |
The better fit depends on your healthcare needs, providers, prescriptions, budget, travel, and coverage priorities.
Know the difference
Medicare Advantage and Medigap are not the same
Medicare Advantage is a way to receive Medicare benefits. Medigap works alongside Original Medicare to help with certain costs.
| Feature | Medicare Advantage | Medigap |
|---|---|---|
| Works with | Provides Part A and Part B benefits through the plan | Works with Original Medicare |
| Provider access | Often uses a plan network | Generally follows Original Medicare provider access |
| Main purpose | Combines Medicare coverage within one private plan | Helps pay certain costs left by Original Medicare |
| Prescription coverage | Included in many plans | Not included, so a separate Part D plan may be needed |
| Can be used together | No, you cannot use Medigap to pay Medicare Advantage plan costs | No, Medigap is designed for use with Original Medicare |
This comparison is educational. Availability, eligibility, benefits, and costs vary.
Make it personal
Compare the details that affect your life
A plan can look attractive at first glance. These five checks help you understand how it may work day to day.
Doctors
Check your providers
Confirm that your preferred doctors, specialists, and hospitals participate in the plan network.
Prescriptions
Review every medication
Check the formulary, drug tiers, pharmacy network, and any plan rules for your prescriptions.
Budget
Compare total costs
Consider premiums, deductibles, copayments, coinsurance, and the annual medical spending limit.
Travel
Think beyond your home area
Review how routine, urgent, and emergency care work when you travel or spend time in another location.
Priorities
Focus on benefits you will use
Compare the coverage and plan rules that matter to your health instead of choosing by extras alone.
Medicare Advantage questions
Clear answers before you choose a plan
Review common questions about using coverage, added benefits, and future changes.
Using your plan
Prescriptions and benefits
Changes and moving
Personalized guidance
Compare Medicare Advantage plans in your area
Share a few details and a licensed sales agent can help you compare providers, prescriptions, costs, and coverage priorities.