Learn about Medicare Advantage Plan options and costs, how to compare plans in your area and how to enroll.
Contributing expert: Kelly Blackwell, Certified Senior Advisor®
Updated: January 23, 2023
Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
Medicare Advantage (MA) Plans, also called Medicare Part C, are the alternative to Original Medicare for your Medicare Part A and Part B coverage. There are different types of MA plans to suit a variety of needs, preferences, and budgets. Availability and costs for MA plans vary depending on the insurer, your location, and your eligibility for the plan.
There are tools and resources available to you to help you compare MA plans, and there are specific enrollment periods when you can sign up or change your plan. Read on to learn how to pick the best Medicare Advantage Plan for you.
All MA plans must provide coverage for Medicare Parts A and B benefits, and most plans include Part D prescription drug coverage. MA plans typically include extra benefits that Medicare doesn’t cover, such as vision, hearing, dental, and fitness club memberships. All MA plans include a maximum out-of-pocket limit that you may spend on in and out-of-network Medicare-covered services. MA insurers can set the max limit lower than what CMS requires.
In general, Medicare Advantage Plans provide health care services to you from a network of providers. MA plan options and offerings vary by county.
There are four main types of Medicare Advantage Plans:
Two less common types of Medicare Advantage Plans are:
Here is a quick comparison of each type of MA:
| Plan type | Part D coverage | Primary Care Physician (PCP) | Referral for specialist | Out-of-network option |
| Health Maintenance Organization (HMO) | Usually (you cannot purchase standalone Part D drug coverage if you have an HMO) | Yes | Yes | No (only with HMO-POS option) |
| Preferred Provider Organization (PPO) | Usually (you cannot purchase standalone Part D drug coverage if you have a PPO) | No | No | Yes, but you pay more for out-of-network services |
| Private Fee-for-Service Plan (PFFS) | Sometimes (you can purchase standalone Part D drug coverage if you have a PFFS) | No | No | You only use Medicare-approved providers that accept your plan’s terms and agree to treat you |
| Special Needs Plan (SNP) | Yes | Yes, or you may need a care coordinator | Yes | Depends on the plan |
| Medical Savings Account (MSA) | No | No | No | MSAs don’t usually have a network of providers |
There are several costs to consider with a Medicare Advantage Plan, including:
Your costs will be lowest if you receive your services and prescription drugs from your plan’s in-network providers and pharmacies. Each MA plan that provides prescription drug coverage (MA-PD) only pays for drugs on its formulary (list of drugs). Generic drugs cost less than brand names or specialty drugs.
For your plan to pay, you must follow your plan’s rules about how you get your benefits. For instance, you may need a referral to see a specialist or prior authorization for a drug or treatment.
Costs are visible on the Medicare.gov website, but review the plan’s Evidence of Coverage document for details about your plan’s benefits, cost-sharing, and rules.
There are intangible costs to consider with Medicare Advantage. Health care is potentially a big-budget item, and the kind of service you receive affects your quality of life.
Past experience with the health care system may help you formulate your priorities to choose the best Medicare Advantage Plan for you.
The best way to compare Medicare Advantage Plans available in your area is to visit Medicare’s online site. You can create an account or continue without signing in. (If you create a personal account, you can save your drug list and won’t have to re-enter it every time you search for a plan).
After you input your zip code and follow a few prompts, you will see a list of MA plans in your area. You can filter your results in the following areas:
You can view a side-by-side comparison of up to three plans at a time with a snapshot of costs and benefits. Dig deeper by clicking ‘plan details.’ You can view each plan’s formulary, preferred providers, and rules for how you get your benefits. You can also explore how much you pay in premiums for more comprehensive coverage of extra benefits.
Each plan will have a Star rating , which Medicare gives based on how well the insurer provides preventive care, chronic condition management, and customer service. Member satisfaction and complaints are also factored into the Star rating.
Comparing plans can take some time and effort. While Medicare has a great tool to get you started, you can also seek help from an expert in your local community. Licensed Medicare insurance agents provide free consultations and help you sign up for a plan. Alternatively, you can contact your local Office on Aging or your State Health Insurance Assistance Program (SHIP) to receive unbiased guidance and one-on-one counseling.
You must be enrolled in Original Medicare Parts A and B to join a Medicare Advantage Plan. There are specific enrollment periods for MA plans:
When you select your plan, follow the plan’s instructions for completing an enrollment application. Many plans will allow you to fill out the application online, although all plans are required to offer an option for a paper enrollment form.
Or, call 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.
You will need to provide your Medicare number, as well as the date your Medicare Part A and Part B coverage began.
