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If you have Medicare, you may already feel overwhelmed by the nuances of the coverage. You have Part A for hospitalizations and Part B for routine care. You may also have a Medicare Part D plan for your prescriptions. Why would you need another type of Medicare coverage, such as an Advantage Plan?

What is a Medicare Advantage Plan?

Also known as Part C plans, Medicare Advantage Plans fill in some gaps with your Part A, Part B, and Part D coverage. The plans are available through private companies. You can find Medicare Advantage plans that offer the same coverage as Part A, B, and D, yet with some limitations on where you can receive care, or you can find a Medicare Advantage Plan that offers coverage that is not available through regular Medicare.

1. HMO

Health Maintenance Organization (HMO) is a common type of Medicare Advantage Plan. With the HMO Medicare Advantage Plan, you will have a network of providers that you choose from in order to maximize coverage. If you go to a provider that is not in the network, you will pay more. You choose your own primary physician, and you will need a referral for any specialists. HMO plans tend to offer the lowest premiums.

2. PPO

Preferred Provider Organization (PPO) Medicare Advantage Plans also have provider networks and you pay more outside the network. The advantages of a PPO is that you don’t have to choose a primary physician, and the PPO plan doesn’t require a referral to see a specialist.


The Private Fee-for-Service (PFFS) Medicare Advantage Plans has an independent fee structure, whereas other Advantage Plans must follow Medicare fees. Some of these plans offer more flexibility in which providers you can see, but you may pay more outside the network. You are only responsible for a co-payment or co-insurance at the time of service. No primary physician or referral for specialists is needed with a PFFS plan.

4. SNP

Special Needs Plan (SNP) is another common type of Medicare Advantage Plan that is designated for people with certain medical conditions. You have to use in-network providers, except in emergencies or if some services are not available in your area within the network. You can qualify for the SNP plan by having specialists already actively involved in your care. Some SMP plans have prescription coverage. You need to choose a primary physician, and referrals to specialists is not required.