5 Things About Medicare Advantage

Medicare offers another way to get the health care coverage that you need through Medicare Advantage. Due to this, choosing the best plan for your needs may seem daunting. To make your Medicare enrollment easier, I listed five (5) things about Medicare Advantage to help you make a more informed decision.


5 things about Medicare Advantage

There are six (6) different types of Medicare Advantage Plans

If you want to enroll in a Medicare Advantage plan, you can choose from several types to suit your needs.

Health Maintenance Organization (HMO) plan

An HMO plan requires you to stay within your plan’s network except for emergency or urgent care or temporary out-of-area dialysis. At most times, you need to choose a primary doctor and get a referral to see a specialist. If you need prescription drugs coverage (Part D), make sure that you join a plan that offers drug coverage.

HMO Point-of-Service (HMOPOS)

An HMOPOS plan provides out-of-network benefits. You may still need, however, to choose a primary doctor and get a referral to see a specialist. Similar to an HMO plan, if you need prescription drugs coverage (Part D), you must select a plan which offers it.

Medical Savings Account (MSA)

An MSA plan allows you to get your health care from any doctor, health care provider, or hospital. Prescription drugs, however, are not covered. If you need drug coverage, you have to join a separate Medicare drug plan. You do not need a primary care doctor nor get a referral to see a specialist.

Preferred Provider Organization (PPO)

A PPO plan allows you to use out-of-network providers for services that are covered. However, some services may entail a higher cost. Some PPO plans also offer drug coverage should you need one. Being in a PPO plan will not require you to choose a primary care doctor. If you want to see a specialist, getting a referral for in-network specialists is usually lower in costs than going to out-of-network specialists.

Private Fee-for-Service (PFFS)

A PFFS plan allows you to go to any Medicare-approved doctor, health care provider, or hospital provided that your treatment or service request and your plan’s payment terms are approved. Not all PFFS plans offer drug coverage. You do not need to choose a primary care doctor nor get a referral to see a specialist.

Special Needs Plan (SNP)

Some SNP plans cover out-of-network services. Make sure to check the plan if they cover out-of-network services and how it affects your costs. An SNP plan covers prescription drugs. Generally, you will need to choose a primary care doctor and get a referral to see a specialist most of the time.


These plans are offered by Medicare-approved private companies

Medicare Advantage plans must follow Medicare rules even when offered by private companies. MA plans cover both Medicare Part A and Part B, emergency or urgent care, and most medically necessary services that the Original Medicare covers.


Some costs are still covered by Original Medicare

Original Medicare still covers some costs such as hospice care, a few new Medicare benefits, and some costs for clinical research studies.


Most Medicare Advantage Plans cover extra benefits

There are certain things that Original Medicare doesn’t cover that most MA plans cover such as:

  • Vision
  • Hearing
  • Dental
  • Fitness program (gym memberships or discounts)
  • Transportation service for doctor or health care provider visits
  • Over-the-counter drugs
  • Services that promote health and wellness
  • Other benefit packages for some chronically ill beneficiaries

Check with the plan to know what additional benefits you can enjoy.


You can change your plan each year or switch back to Original Medicare

These are the times when you can join, change, or drop a Medicare Advantage plan:

  • Initial Enrollment Period
    This is when you are first eligible for Medicare.
  • General Enrollment Period
    This is when you get Part B coverage for the first time. Your new coverage will begin July 1.
  • Open Enrollment Period
    This happens between October 15 and December 7. Your new coverage will begin on January 1.

These are the 5 things about Medicare Advantage that I hope can help you understand the different options you have when joining Medicare. If you like to learn more, visit Medicare.gov or download the Medicare & You Guide (eBook) here.


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