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Medicare Advantage Plans
Medicare Advantage Plans, sometimes called Medicare Part C, 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 the Medicare Advantage Plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:
- Medicare Health Maintenance Organization (HMOs)
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service Plans
- Medicare Special Needs Plans
When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan*. Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO) and you may have to see doctors that belong to the plan or go to certain hospitals to get services.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that it offers. In 2025, the standard Part B premium amount is $185.00 (or higher, depending on your income). However, some people who get Social Security benefits pay less than this amount.
When can I enroll?
Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning three months before the month you turn 65 and ends three months after the month you turn 65.
For example, if you turn 65 on May 5, your eligibility period starts on February 1 and ends on August 31.
- If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability.
- You can switch or drop your Medicare Advantage during an enrollment period between October 15 and December 7 of each year.
This information was obtained from www.medicare.gov
* Page 2 https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf
Different Types of Medicare Advantage Plans
Medicare Advantage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
Medicare Advantage Plans include the following:
Health Maintenance Organization (HMO) Plan
In most HMO Plans, you can only go to doctors, other health care providers, or hospitals on the plan’s list, except in an emergency, for out-of-area urgent care or for temporary out-of-area dialysis. You may also need to obtain a referral from your primary care doctor to consult with other doctors or specialists. Find and compare HMO Plans in your area.
Preferred Provider Organization (PPO) Plans
A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You pay more if you use doctors, hospitals, and providers outside of the network.
Private Fee-for-Service (PFFS) Plans
A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medicare supplement. The plan determines how much it will pay doctors, other healthcare providers, and hospitals, as well as how much you must pay when you receive care.
Medicare Special Needs (SNP) Plans
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
Find out who can join a Medicare SNP
These definitions are directly from www.medicare.gov
By contacting the phone number on this website, you will be directed to a licensed insurance agent.
This is a solicitation for insurance. Submitting information or calling numbers listed on this website will direct you to a licensed Agent/Broker.
Important disclosures about Medicare Plans: Medicare has neither endorsed nor reviewed this information. Not connected or affiliated with any United States Government or State agency. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.