Medicare Advantage Plans

Medicare Advantage Plans are sold by private insurers approved by Medicare, and provide your Part A and B coverage, cover "medically necessary" benefits, and sometimes include Part D drug coverage.

The most common MA Plan types are:

Health Maintenance Organization (HMO). HMOs require you to see doctors on their approved list, but also tend to offer greater benefits and lower costs.

Preferred Provider Organization (PPO). PPOs let you see any doctor, but you pay less if you see plan-approved doctors.

Private Fee For Service (PFFS). PFFS Plans let you see any doctor who accepts the plan’s payment.
BE CAREFUL: Not all doctors accept all PFFS Plans.

Medicare Advantage Prescription Drug Coverage

Some Medicare Advantage Plans also offer drug coverage; these plans are called Medicare Advantage Prescription Drug Plans (MAPD Plans). All MAPD plans are required to cover everything that Original Medicare (Part A and Part B) covers.

In addition to Medicare Part D prescription drug coverage, many of these plans can include other benefits such as hearing, routine vision and comprehensive dental, and access to wellness programs (Ex: Silver Sneakers). Although you must use drugs on an approved list, the plan may pay part of your Part B or D premium, cover drugs through the coverage gap, and often offer cheaper copayments for generic or mail-order drugs.

Note: if you are in a MA Plan with drug coverage and you join a stand-alone drug plan, then you may be disenrolled from your MA Plan and return to Original Medicare.

Special Needs Plans

Special Needs Plans (SNPs), another type of Medicare Advantage Plan, offers services and benefits especially tailored for people who need specialized care and/or focused care management. Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Read More About SNPs

Last Updated: 10/12/2018
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