Medicare Advantage
Medicare Advantage (Part C) plans are offered by private insurers and may bundle hospital and medical coverage, often with additional benefits. Review networks, prescriptions, costs, and plan details before enrolling.
Medicare Education
Understand Medicare Advantage before you choose.
Medicare Advantage, also called Part C, provides another way to receive your Part A and Part B benefits through a Medicare-approved private plan. Understanding networks, prescription coverage, and total costs can help you compare your options.
Coverage comes together
Most plans combine medical and prescription benefits. Additional benefits depend on the plan.
Access rules matter
Check your doctors, hospitals, referral requirements, and prior authorization rules.
Look beyond the premium
Compare deductibles, copayments, coinsurance, and the plan’s annual medical spending limit.
Explore common plan types.
Select a plan type to review its main features.
HMO — Health Maintenance Organization Care generally centers on a network of participating providers.
An HMO generally requires you to use its network for covered care, with exceptions such as emergency care, out-of-area urgent care, and temporary out-of-area dialysis.
How care is arranged
- You usually choose a primary care doctor.
- Specialist referrals are generally required, with exceptions.
- Some HMO-POS plans permit certain out-of-network services at a higher cost.
What to check
- Whether your preferred doctors and hospitals participate
- Prescription coverage and pharmacy options
- Referral and prior authorization requirements
PPO — Preferred Provider Organization In-network and out-of-network care generally have different costs.
PPOs offer coverage outside their networks, usually at a higher cost. Confirm that an out-of-network provider will accept you and that the service is covered.
How care is arranged
- A primary care doctor is generally not required.
- Specialist referrals are generally not required.
- Prior authorization may still be necessary for some services.
What to check
- In-network and out-of-network cost-sharing
- Medical spending limits for each type of care
- Whether drug coverage is included
PFFS — Private Fee-for-Service Provider access depends on the plan’s payment terms and participation.
A PFFS plan sets what it pays providers and what you pay for care. Some plans have networks. Outside a network, a provider generally must agree to the plan’s terms before treating you, except for emergency care.
How care is arranged
- You do not need to choose a primary care doctor.
- Specialist referrals are not required.
- Confirm acceptance before each visit to a non-network provider.
What to check
- Provider participation and any network rules
- What you pay for services
- Whether Part D is included; if not, a separate drug plan may be available
SNP — Special Needs Plans Plans for people who meet specific health or eligibility requirements.
SNPs tailor coverage and care coordination to particular groups. All SNPs include Part D prescription drug coverage. Network and referral rules depend on the plan.
C-SNP
For people with qualifying severe or disabling chronic conditions covered by the plan’s eligibility criteria.
D-SNP
For people with Medicare and qualifying Medicaid eligibility. The required Medicaid status depends on the plan.
I-SNP
For people meeting qualifying institutional residence or institutional-level care requirements.
Compare the details that affect your everyday care.
A plan’s name or advertised premium tells only part of the story. Use your healthcare needs as the starting point.
- Doctors and hospitals: Verify participation with both the plan and the provider.
- Prescriptions: Review your exact medications, dosages, restrictions, and pharmacy costs.
- Total expenses: Compare premiums, deductibles, copayments, and coinsurance.
- Care approvals: Understand referrals and prior authorization requirements.
- Travel: Check routine care access when you are away from home.
- Extra benefits: Review eligibility, allowances, limits, and participating providers.
Have questions about your next step?
Contact David Anderson at Certified Financial Group, LLC to discuss your questions and how healthcare costs fit into your retirement planning.
Educational information: This overview describes selected Medicare Advantage plan types and is not a complete list of available options. Benefits, costs, networks, eligibility, and availability vary by plan and location. Review the plan’s current Evidence of Coverage and confirm details before enrolling. Certified Financial Group, LLC is not affiliated with or endorsed by Medicare or any government agency. External links open in a new tab.