In general, a Medicare Advantage plan is a health plan option approved
by the Centers for Medicare & Medicaid Services (CMS) and operated
by a private insurance company. Sometimes, you will hear a Medicare
Advantage plan called a "Medicare Part C plan" or a Medicare Health plan.
A Medicare Advantage MAPD (or MA-PD )includes Medicare Part D prescription drug coverage and a Medicare Advantage MA plan does not include drug coverage.
Both MA and MAPD Medicare Advantage plans provide a combination of your Medicare Part A (in-patient or hospital coverage) and Medicare Part B (out-patient or physician coverage) and may also include other "supplemental" service such as limited home healthcare, vision coverage, dental coverage, transportation, and recreational coverage (such as a "Silver Sneakers" membership).
Important: You may not be able to add Medicare drug coverage to an MA.
If you join an MA
plan (without prescription drug coverage), you may not be allowed
to also add a stand-alone Medicare Part D prescription drug plan (PDP
). If you want prescription drug coverage and want to join a Medicare Advantage plan, then you probably should choose an MAPD
. Only MSAs and PFFS Medicare Advantage plans can add stand-alone Medicare Part D drug coverage (see more below). However, if you receive VA drug coverage, you can join an MA plan and use your creditable VA drug coverage or you can join an MAPD plan and use either your VA drug coverage or your MAPD drug coverage (but not both at the same time).
You can read more in our Frequently Asked Question: "Can I enroll in an HMO and then add prescription drug coverage through a stand-alone Medicare Part D plan?
" (Spoiler Alert: No
You can also read more in our Frequently Asked Question: "If I have VA drug benefits can I also add Medicare Part D prescription drug coverage?
" (Spoiler Alert: Yes
A note on Medicare Advantage plans and Healthcare Networks
Most MAs and MAPD
have healthcare networks and you may need to visit doctors (or other
healthcare providers) who are part of the Medicare Advantage plan
network - or be prepared to pay a higher coverage cost.
Types of Medicare Advantage Plans (MA and MAPD)
You can use our Medicare Advantage Plan Finder
to browse through the Medicare Advantage plans
. As you review plan in your ZIP Code region, you might notice some common types of Medicare Advantage plans.
- HMO - Health Maintenance Organization plans
are wellness-based Medicare Advantage plans and usually have the
most-restrictive healthcare provider network, meaning that your
healthcare costs may be considerably higher if you go outside of your
plan’s established network. Also, depending on your HMO plan, you may
only be allowed outside of your plan network with a referral from your
doctor. Local HMOs are often very affordable compared to other Medicare
Advantage plans because the restrictive network and focus on wellness
helps to control healthcare costs. The majority of Medicare
Advantage plans will be HMOs (Health Maintenance Organizations).
- HMO-POS - Health Maintenance Organizations
These Medicare Advantage HMO’s have a more flexible
healthcare network allowing you to seek care outside of your plan’s
network by paying a higher cost-sharing rate. This type of HMO is
chosen often for people who travel part of the year, but still return
home for the majority of their healthcare needs. For instance, you may
have a $30 co-payment when you visit a healthcare provider in-network
(at home) and pay $60 when you visit a provider outside of the plan’s
network (while traveling).
(1) Sometimes an HMO
POS plans will convert to HMOs (without the POS option) for the following plan year.
(2) Depending on your HMO POS, you may find that out-of-network costs
do not apply to your plan's that your Maximum Out-of-Pocket (MOOP)
limit - check with your plan's Member Services for more details.
- PPO - Preferred Provider Organization plans
Medicare Advantage PPOs have a less-restrictive provider network, but
again, you probably will pay a higher cost-sharing rate when you visit a
healthcare provider outside of your plan’s network.