Your complete quick guide to Medicare Advantage Plans

The US government offers helpful Medicare insurance plans to all seniors, especially those who’ve worked in the US for at least ten years. Medicare Part A’s monthly premium is free for these seniors since the medical taxes for their work over the years cover the premium cost.

Even though Medicare Part A and Part B cover lots of areas for seniors, there are still benefits that people enrolled in Original Medicare do not have access to.

To boost the covered benefits and elevate them to a higher level, private insurance companies offer Medicare Advantage plans, also known as Medicare Part C. it is important to note that Medicare Advantage plans are privately offered advanced original Medicare plans.

Types of Medicare Advantage Plans

Private companies offer multiple types of Medicare Advantage plans and can be chosen per your needs. It’s often better to have your Medicare insurance done through Medicare advantage plans since the original Medicare does not cover all of your needs. Here are the best common Medicare Advantage plan types you need to know about.

1) Health Maintenance Organization (HMO) plans

HMO plans are one of the best Medicare Advantage Plans. In an HMO plan, most of the services, including doctors, hospitals, and other healthcare providers, that you avail must be inside the plan’s network. However, out-of-area dialysis, out-of-area urgent care, and emergency care can be availed outside the network. Prescription drug coverage is also included in most HMO plans. 

HMO point-of-service plans may benefit you by allowing you to get services outside the plan’s network in exchange for a higher copayment or coinsurance payment. You also need to choose a primary care doctor in your HMO plan.

It’s very critical to know the terms and conditions and the rules of your plan before you enroll in it, and this generally applies to any of the plans you choose. If you choose a doctor outside the plan’s network, you may be liable to pay the total amount.

2) Preferred Provider Organization (PPO) Plans

Another common type of Medicare Advantage Plan (Medicare part C) is the Preferred Provider Organization Plan. PPO plans provide you flexibility in terms of choosing a doctor for your care. You can choose a doctor outside the plan’s network and have to pay a little more in that case.

Unlike HMO plans, you do not have to pay the total amount if you choose a doctor outside the range of the

plan’s network. Similarly, you pay less if the doctor is within the plan’s network. Choosing a plan’s preferred healthcare provider can also reduce your cost.

A crucial thing to do while choosing a PPO plan is to ensure that the plan offered contains prescription drug coverage if you require it. If you don’t have prescription drug coverage in your Preferred Provider Organization plan, you won’t be able to enroll in a separate Medicare Part D (prescription drug coverage) insurance.

3) Private Fee-For-Service (PFFS) plans

A PFFS plan is one of the Medicare Advantage Plans that is distinct from an Original Medicare plan or Medigap: it decides the fraction of the amount that is to be paid by you when you get healthcare and the plan provider through its annual “Evidence of Coverage”.

It depends if you can choose your choice of hospital, doctor, and other healthcare services upon the plan in some cases. If your enrolled PFFS plan has its provider’s network, you may choose them or another network that has agreed to treat people from your plan. You also get mandatory treatments in case of emergency. 

Typically, if you go outside the network range, your costs could be higher, or the plan may not cover the costs at all. Prescription drug coverage (Medicare part D) is included in most of the PFFS plans. Unlike a PPO plan, if your plan does not cover Medicare part D, you can get enrolled in it separately.

4) Special Needs Plans (SNPs)

Special Needs Plans are an efficient type of Medicare Advantage Plan dedicated to those individuals who unfortunately require treatment for a specific ailment or a condition. SNPs are best for those who want their benefits, medications, and services in a particular domain.

The best part about SNPs is that they all include prescription drug coverage. Individuals residing in a nursing care home or a similar institution are eligible for a Special Need Plan, along with those eligible for both Medicare and Medicaid. People with chronic diseases and conditions are also eligible for SNPs.

Other less common types

HMO point-of-service (HMOPOS) is a subset of HMO plans that allows you to get out of the plan’s network coverage with an additional amount to be paid.

Medicare Medical Savings Account (MSA) plan is the join of the Medicare Advantage plan with a high deductible and a bank account. The plan sends money to your account, which you can use to pay for your healthcare. It requires certain out-of-pocket payments before the coverage starts.

A quick guide on how to enroll in a Medicare Advantage Plan

You need to analyze what insurance agencies offer services in your area and find a suitable plan. You can use a Medicare Plan finder or visit an agency’s website and see the details online. You need to fill out an enrollment plan and submit it to the provider. Once you’ve joined, you’ll get your Medicare number and the date of coverage start.

How to switch to a different Medicare Advantage Plan

During the enrolment period, you can choose and enroll in a Medicare Advantage Plan, which you need to switch to. You’ll be automatically unenrolled from the previous plan when it expires. 

Rules and Costs of Medicare Advantage Plans

The cost of the Medicare Advantage Plan depends upon the services covered by the plan you want to enroll in. Various factors determine the prices of different plans, depending on whether you use the healthcare services within the plan’s network. These plans have an annual out-of-pocket limit, meaning you don’t need to pay extra once the amount is paid.

A fixed monthly amount is paid by Medicare to the insurance providers offering Medicare Advantage Plans. The out-of-pocket expenses the buyer has to bear depend upon the plan and its services. The rules of Medicare Advantage Plans differ each year.


It’s very important to know what your requirements are before enrolling in a Medicare Advantage Plan. Once you know what plan you choose, you must acquire an in-depth knowledge of all the possible cases your plan covers from your insurance providers. Many insurance agencies have skilled agents who can provide you with consultancy advice to get you the best plan for your needs. And in many cases, you do get a plan that cuts down your costs to a surprising level.