Networks, prescriptions, costs, coverage rules, and extra benefits can work differently from one plan to another. We help you understand those differences before you make a decision.
Provider AccessDoctors, hospitals, networks
Prescription CoverageFormularies and pharmacies
Realistic CostsPremiums and cost sharing
Coverage RulesReferrals and approvals
A Medicare Advantage Plan is another way to receive your Medicare Part A and Part B benefits through a private company approved by Medicare. The details of how you access and pay for care depend on the specific plan.
MEDICARE PART AHospital coverage
MEDICARE PART BMedical coverage
The plan must provide your Medicare-covered Part A and Part B services, but its network, costs, rules, drug coverage, and additional benefits may differ from other plans.
Medicare Advantage Plans cover Medicare-covered hospital and medical services. Your copayments, coinsurance, deductibles, provider access, and other plan details may differ from Original Medicare.
Drug coverage is based on the plan’s formulary, pharmacy network, coverage stages, and rules. A plan should be checked against your complete prescription list—not just its premium or extra benefits.
Plans may offer benefits such as routine dental, vision, hearing, fitness, transportation, or other services. The benefit amount, provider access, limitations, and actual usefulness vary by plan.
The amount varies by plan and may work differently for in-network and out-of-network care. Once you reach the plan’s applicable limit, the plan pays 100% of covered health services for the rest of that calendar year.
Depending on the plan, you may need to use network providers, select a primary care provider, get referrals, or receive prior authorization for certain services. These details should fit how and where you receive care.
If you elect the Medicare hospice benefit while enrolled in Medicare Advantage, Original Medicare generally covers your hospice care. Your Medicare Advantage Plan can still cover services unrelated to your terminal illness and may offer additional benefits.
Benefits, costs, networks, formularies, and coverage rules vary by plan and may change each year. Review the plan’s official materials for complete details.
The letters are only the beginning. Select a plan structure to see how provider access, prescriptions, eligibility, and plan rules generally work.
A more coordinated approach built primarily around a contracted provider network.
PROVIDER ACCESSNetwork centeredExcept for emergencies, urgent care, and certain other situations, you generally use providers in the plan’s network.
SPECIALISTSReferrals are commonMost HMO plans require a referral to see a specialist, although exceptions and plan rules vary.
PRESCRIPTIONSOften includedWhen included, coverage follows the plan’s formulary, pharmacy network, tiers, and drug rules.
STRUCTURECoordinated careA primary care provider may play a central role in helping coordinate covered services.
A network-based plan that generally allows covered care outside the network at a higher cost.
PROVIDER ACCESSIn or out of networkYou generally pay less with network providers and more when using covered out-of-network care.
SPECIALISTSUsually no referralPPO plans generally do not require a referral to see a specialist, but other coverage rules can still apply.
PRESCRIPTIONSOften includedVerify every medication, dosage, pharmacy, drug tier, and applicable coverage requirement.
COST STRUCTURETwo cost levelsIn-network and out-of-network deductibles, cost sharing, or limits may work differently.
A Special Needs Plan designed around one qualifying severe or disabling chronic condition—or a related group of conditions.
ELIGIBILITYCondition specificYou must have a condition served by the plan and satisfy its eligibility-verification requirements.
AVAILABILITYLocal plan requiredA C-SNP serving your qualifying condition must be offered in your service area.
TAILORED COVERAGEDesigned for the groupBenefits, providers, and drug coverage are tailored to the specific population the plan serves.
PLAN STRUCTUREHMO or PPO rulesThe C-SNP may use an HMO or PPO structure, so network and referral rules still matter.
A Special Needs Plan for people who qualify for both Medicare and Medicaid.
ELIGIBILITYMedicare + MedicaidYou must have Medicare and an eligible level of Medicaid; plan requirements can differ.
COORDINATIONTwo programs, coordinatedThe plan may help coordinate Medicare and Medicaid benefits, providers, and member support.
COSTSStatus mattersYour Medicaid eligibility category can affect premiums, cost sharing, and additional assistance.
PLAN STRUCTUREDetails still varyD-SNPs can differ in integration, network, referrals, benefits, and local availability.
A consumer-directed Medicare Advantage option combining a high-deductible health plan with a plan-funded savings account.
THE ACCOUNTPlan-funded depositThe plan deposits money into your account. You decide how to use the funds, subject to applicable tax rules.
THE PLANHigh deductibleThe health plan begins paying for Medicare-covered Part A and Part B services after the deductible is met.
PROVIDER ACCESSUsually no networkYou can generally choose your health care providers, but confirm that a provider accepts the plan’s terms.
PRESCRIPTIONSPart D is separateMSA plans do not include Part D. You can enroll in a separate Medicare drug plan if eligible.
Your doctors, prescriptions, preferred hospitals, travel, budget, and eligibility tell us more than a plan label ever could.
Where does PACE fit? The Program of All-Inclusive Care for the Elderly is a separate Medicare and Medicaid program—not a Medicare Advantage plan type. It has its own eligibility and service-area requirements.
This comparison provides general educational information. Plan availability, eligibility, networks, benefits, costs, and rules vary and may change each year.
A benefit summary can look impressive. The better test is whether the plan supports the doctors, prescriptions, locations, costs, and routines that matter to you.
Select each priority to see what deserves verification before enrollment.
Verify primary care, specialists, hospitals, outpatient facilities, labs, imaging centers, and other providers you expect to use. A provider’s participation can differ by specific plan and can change.
A medication may be covered differently depending on its tier, dosage, quantity limit, prior-authorization requirement, or pharmacy. Use a complete and current prescription list.
Consider deductibles, office visits, specialists, tests, hospital care, outpatient procedures, prescriptions, and the plan’s annual out-of-pocket limit. The lowest premium is not automatically the lowest total cost.
Emergency and urgently needed care have protections, but routine non-emergency access away from the plan’s service area depends on the plan structure and specific coverage rules.
Dental, vision, hearing, fitness, transportation, over-the-counter allowances, and other benefits can have networks, limits, schedules, and eligibility rules. Confirm the practical value—not only the advertised amount.
Bring your doctors, prescriptions, preferred facilities, travel needs, and health priorities. Those details create a more meaningful comparison.
Provider participation, formularies, pharmacy status, benefits, costs, and coverage rules vary by plan and may change. Always verify current information with the plan and provider.
Certain health conditions or Medicaid eligibility may open access to a Medicare Advantage Special Needs Plan. The first step is understanding which path—if either—matches your circumstances.
WORTH A FRESH LOOKYour Medicare options are not always static.
A C-SNP serves people with a specific severe or disabling chronic condition—or a defined group of related conditions. The plan must be available where you live and must verify that you meet its eligibility requirements.
The condition must qualifyA diagnosis alone does not guarantee eligibility for every C-SNP.
The plan must serve your areaAvailability and the conditions served vary by county and plan.
Coverage is tailoredBenefits, providers, care coordination, and drug coverage support the group served.
Diabetes, chronic heart failure, certain cardiovascular disorders, End-Stage Renal Disease, dementia, and other Medicare-recognized severe or disabling conditions.
Examples are not exhaustive, and an individual plan may serve only selected conditions.A D-SNP serves people who have Medicare and an eligible level of Medicaid. Because Medicaid eligibility categories differ, the plan must verify that your particular Medicaid status meets its requirements.
Both programs are involvedYou need Medicare and a Medicaid status accepted by the plan.
Benefits may be coordinatedThe plan may help organize coverage and member support across both programs.
Your Medicaid level mattersCost sharing and available assistance depend on your eligibility category.
Your current Medicaid category, providers, prescriptions, plan integration, additional benefits, and how costs are handled.
Not every person with Medicaid qualifies for every D-SNP offered locally.SPECIAL ENROLLMENT PERIODYou may not need to wait for fall.
Identify the changeHealth, Medicaid status, or another qualifying circumstance
Verify eligibilityCondition, assistance level, service area, and plan requirements
Confirm the timingDetermine whether a Special Enrollment Period applies
Special Enrollment Period availability and timing depend on the specific qualifying situation. Eligibility must be confirmed before enrollment.
Tell us what changed. You do not need to know which plan type or enrollment period applies.
This page provides general educational information and is not an eligibility determination. Plan availability, qualifying conditions, Medicaid requirements, benefits, and enrollment periods vary.
A Medicare Medical Savings Account combines a high-deductible Medicare Advantage plan with a special savings account funded by the plan. It gives you more responsibility—but also a different kind of flexibility.
The plan deposits a set amount into the account, generally at the beginning of the calendar year.
You decide whether to use account funds or other funds for health care expenses before the deductible is met.
After you meet the annual deductible, the plan begins covering Medicare-covered costs according to its terms.
Only Medicare-covered Part A and Part B expenses count toward the MSA plan deductible.
Select each topic to see what makes this plan type different.
You can use Medicare-approved providers and facilities that agree to treat you and have not opted out of Medicare. MSA plans do not require a primary care doctor or specialist referral.
Money left in the MSA at the end of the year stays in the account and may be used for health care expenses in future years.
You are responsible for managing the money and deciding whether to use account funds or other funds for a particular health care expense.
Medicare MSA plans do not include prescription drug coverage. If you want Part D, you must enroll in a separate Medicare drug plan and compare that coverage independently.
The plan deposit may be less than the annual deductible. If the account is exhausted, you may pay additional Medicare-covered costs out of pocket until the deductible is reached.
We’ll look at the deductible, provider flexibility, prescriptions, expected care, and whether an MSA is actually available and appropriate for you.
This section provides general educational information. Plan availability, deposits, deductibles, covered services, extra benefits, and enrollment eligibility vary. Account funds used for non-qualified expenses may have tax consequences. You must continue paying your Medicare Part B premium.
For an eligible older adult who needs a nursing-home level of care, PACE may bring medical care and everyday support together—helping the person remain safely connected to home and community.
PACE is a comprehensive Medicare and/or Medicaid medical and social services program—not another Medicare Advantage plan. All four conditions below must be satisfied.
PACE begins at age 55, not only at traditional Medicare age.
PACE is only available within designated local service areas.
The person’s state must certify that level of care is needed.
The person must be able to remain safely in the community with help.
“Nursing-home level of care” does not mean the person must already live in a nursing home. PACE is designed to help eligible adults receive coordinated support in the community whenever that can be done safely.
The PACE team develops an individualized care plan based on the participant’s medical, physical, social, and emotional needs. Select a category to explore what that support may include.
PACE is a comprehensive program that coordinates approved medical and social services through its own care team and provider structure. Participants receive care through the PACE organization and its approved providers.
You do not need to determine eligibility alone. We can help you understand the program, local service-area requirements, and the questions to ask next.
This section provides general educational information and is not an eligibility determination. PACE availability, service areas, care approval, provider requirements, costs, and enrollment eligibility vary. The state and PACE organization must confirm eligibility.
Medicare Advantage plans can look similar at first glance. The meaningful differences appear when we compare them around your doctors, prescriptions, expected costs, travel, and priorities.
DoctorsNetworks and hospitals
PrescriptionsFormularies and pharmacies
CostsPremiums and cost sharing
PrioritiesTravel and useful benefits
Insurance company logos are shown for identification and do not indicate that every company or plan is available to every visitor. Plan availability, benefits, provider networks, drug coverage, costs, and eligibility vary by ZIP code, county, and contract year. The licensed agents associated with this website do not offer every plan available in every area.
Start with the fundamentals, then compare the details that apply to your ZIP code, doctors, prescriptions, health needs, and budget.
Medicare Advantage, also called Part C, is another way to receive your Medicare Part A and Part B benefits through a Medicare-approved private insurance company. You must have Part A and Part B, live in the plan’s service area, and continue paying your Part B premium. Most plans include Part D drug coverage, and some offer additional benefits.
An HMO generally requires you to use the plan’s network except for situations such as emergency care, urgent care, or out-of-area dialysis, and it may require a primary doctor and specialist referrals. A PPO also has a network but usually allows out-of-network Medicare-covered care at a higher cost and generally does not require referrals. Exact rules vary by plan.
That depends on the plan type and its current provider network. Verify every important doctor, facility, and health system before enrolling—then check again during each annual review because provider networks can change. It is wise to confirm with both the plan and the provider’s office.
Most do, but not all. If you want drug coverage with an HMO or PPO, you generally need to choose one that includes Part D because joining a separate drug plan is usually not allowed with those plan types. Medicare MSA plans do not include Part D, so MSA members may choose a separate Medicare drug plan.
It is the plan’s yearly limit on what you pay for covered medical services that count toward that limit. After you reach it, the plan pays 100% of covered health services for the rest of the calendar year. The amount and what counts can vary, and prescription drug spending follows separate Part D rules.
No. A $0 plan premium means the plan does not charge an additional monthly premium, but you generally must continue paying your Medicare Part B premium. You may also have deductibles, copayments, coinsurance, drug costs, or costs for services the plan does not cover.
Yes. Your plan sends an Annual Notice of Change each fall explaining coverage and cost changes that take effect in January. Provider networks can also change, which is why reviewing your doctors, prescriptions, costs, and benefits every year is so important.
These are Medicare Advantage Special Needs Plans. A C-SNP serves people who meet the plan’s requirements for a qualifying severe or disabling chronic condition. A D-SNP serves eligible people who have both Medicare and Medicaid. Availability, accepted conditions, Medicaid requirements, networks, and benefits vary by plan and service area.
A Medicare MSA is a consumer-directed Medicare Advantage plan combining a high deductible with a plan-funded savings account; it generally has broad Medicare-provider access and requires separate Part D coverage if desired. PACE is not a Medicare Advantage plan—it is a comprehensive Medicare and/or Medicaid medical and social services program for people who meet its age, location, care-level, and community-living requirements.
You may have an Initial Enrollment Period when first eligible, the annual Open Enrollment Period from October 15 through December 7, or a Special Enrollment Period after certain qualifying events. If you are already enrolled in Medicare Advantage, the Medicare Advantage Open Enrollment Period runs January 1 through March 31 and generally allows one change. The opportunity that applies depends on your circumstances.
You do not need to know the correct plan name or enrollment period. Start with the question that brought you here.
This FAQ provides general educational information. Plan availability, rules, provider participation, benefits, costs, drug coverage, and enrollment eligibility vary. Review official plan documents and confirm details before enrolling.
Start with your questions, doctors, prescriptions, expected care, and priorities. From there, we can determine which Medicare paths deserve a closer look—and which do not.
Choose a convenient appointment time and talk through the Medicare Advantage options and questions that apply to you.
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Needs before plansDoctors, drugs, costs, and priorities
No pressure to changeUnderstanding comes first
Scheduling a conversation or asking a question does not require you to enroll in or change a Medicare plan. Plan availability and eligibility vary.
