Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:
  • HMO's - Medicare Health Maintenance Organizations are contracted with the federal government under the Medicare Advantage program (formerly called Medicare+ Choice) to provide health benefits to persons eligible for Medicare that choose to enroll in the HMO, instead of receiving their benefits and care through the traditional fee for service Medicare program.
  • PPO's - Medicare Preferred Providers Associations. With a Medicare Advantage PPO, you are able to see any doctor you want, however, if you use a doctor who participates in the network, you get a better benefit and lower co-payment than if you visit a non-network doctor. Referrals aren't needed and you are not required to see a primary care doctor first. In addition to prescription drug benefits, Medicare Advantage PPOs may offer additional benefits such as dental, vision, and nutritional supplements. If you select a Medicare Advantage PPO, it replaces your Original Medicare coverage. However, you can return to Original Medicare down the road if you wish.
  • PSO's - Provider Sponsored Organizations-Like HMO's except they are formed by a group of hospitals and doctors who directly take on the financial risk of providing comprehensive health care coverage for Medicare beneficiaries. There is no insurance company involved.
  • PFFS - Medicare Private fee for service plans. With a Medicare Advantage PFFS plan, you have the freedom to select any doctor, hospital, or health care provider the PFFS payment terms and conditions, without worrying about referrals or a list of doctors who participate in the plan's network. PFFS plans feature limits on out-of-pocket expenses, coverage for emergency and urgent care, and in some cases, a prescription drug benefit.
  • SNP - Medicare Special Needs Plans Medicare Advantage Coordinated Care Plan focused on individuals with special needs such as
    • Institutionalized beneficiaries (those who reside or is expected to reside for 90 days or longer in a long term care facility or living in a community but is requiring an equivalent level of care as those living in a long term care facility.
    • Dually eligible beneficiaries (entitled to a state medical assistance).
    • Beneficiaries with chronic conditions.


*Note: Medicare Advantage Plans do not work with Medigap policies.

You must have Medicare Part A and Part B to join a Medicare Advantage Plan. You will still have to pay your monthly Medicare Part B premium to Medicare and you may pay a monthly premium to your Medicare Advantage Plan for the extra benefits such as dental, vision, and or chiropractic services.