Medicare Advantage health plans provide 

Part A (Hospital Insurance) and Part B (Medical Insurance) benefits to people with Medicare. These plans are generally offered by private companies that contract with Medicare. They include:

 Medicare Advantage Plan (Part C)
A type of Medicare-approved health plan from a private company that you can choose to cover most of your Part A and Part B benefits instead of Original Medicare. It usually also includes drug coverage (Part D).  

 Medicare Cost Plan 
A type of Medicare health plan available in some areas. In a Medicare Cost Plan, if you get services outside of the plan's network without a referral, your Medicare-covered services will be paid for under Original Medicare (your Cost Plan pays for emergency services or urgently needed services).

• Demonstrations/Pilots
• Program of All-inclusive Care for the Elderly (PACE).

Program of All-inclusive Care for the Elderly (PACE) 
A special type of health plan that provides all the care and services covered by Medicare and Medicaid as well as additional medically necessary care and services based on your needs as determined by an interdisciplinary team. PACE serves frail older adults who need nursing home services but are capable of living in the community. PACE combines medical, social, and long-term care services and prescription drug coverage. 

An HMO is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. When you have an HMO, you generally must get your care and services from doctors, other health care providers, and hospitals in the plan's network, except:

• Emergency care
• Out-of-area urgent care
• Temporary out-of-area dialysis

Some HMOs are Point-of-Service (HMOPOS) plans that may allow you to get some services out-of-network for a higher 

copayment or coinsurance. It’s important that you follow the plan’s rules, like getting prior approval for a certain service when the plan requires it.

• Question: Do these plans charge a monthly premium? 
• Answer: Yes. These plans usually charge a premium, in addition to the monthly Part B (Medical Insurance) premium. 
• Question: Do these plans offer Medicare drug coverage (Part D)? 
• Answer: Usually. Prescription drugs are covered in most HMOs. Check with the plan you’re interested in.

HMOs & drug coverage 

If you want prescription drug coverage, you have to join an HMO that offers it. If you join an HMO plan that doesn't offer drug coverage, you can't join a separate Medicare drug plan. 

• Question: Can I use any doctor or hospital that accepts Medicare for covered services?
• Answer: Sometimes. You generally must get your care and services from doctors, other health care providers, and hospitals in the plan’s network (except for emergency, urgent care, or out-of-area dialysis). In an HMOPOS plan, you may be able to get some services out of network for a higher copayment or coinsurance.
• Question: Do I need to choose a primary care doctor? 
• Answer: Usually. In most HMOs you need to choose a primary care doctor. 
• Question: Do I have to get a referral to use a specialist? 
• Answer: Yes. In most cases, you have to get a referral to use a specialist in HMO Plans. Certain services, like yearly mammogram screenings, don't require a referral.

What else do I need to know?

• If you get health care outside the plan's network, you may have to pay the full cost.
• If your plan gives you prior approval for a treatment, the approval must be valid for as long as the treatment’s medically necessary. Also, your plan can’t ask you to get additional approvals for that treatment. If you’re currently getting treatment and you switch to a new plan, you’ll have at least 90 days before the new plan can ask you to get a new prior approval for your ongoing treatment.
• If your doctor or other health care provider leaves the plan, your plan will notify you. You can choose another provider in the plan.
• Your plan can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
• Check with the plan you’re interested in for specific information.

A PPO is a type of 

Medicare Advantage Plan (Part C) offered by a private insurance company. PPOs have networks of doctors, other health care providers, and hospitals.

• You pay less if you go to providers and facilities that are belong to the plan's network.
• You can generally go to out‑of‑network providers for covered services, but you’ll usually pay more.

• Question: Do these plans charge a monthly premium? 
• Answer: Yes. These plans usually charge a premium, in addition to the monthly Part B (Medical Insurance) premium. 
• Question: Do these plans offer Medicare drug coverage (Part D)? 
• Answer: Usually. Prescription drugs are covered in most PPO Plans. Check with the plan you’re interested in.

PPOs & drug coverage

If you want prescription drug coverage, you have to join a PPO that offers it.  If you join a PPO that doesn’t offer drug coverage, you can’t join a separate Medicare drug plan.

• Question: Can I use any doctor or hospital that accepts Medicare for covered services?
• Answer: Yes. You can also use out-of-network providers for covered services, if they’re participating in Medicare or accept assignment, but you'll usually pay more. Before you get services from an out-of-network provider, contact your PPO Plan to ensure the services are medically necessary and covered by your plan. You’re always covered for emergency and urgent care.
• Question: Do I need to choose a primary care doctor? 
• Answer: No. 
• Question: Do I have to get a referral to see a specialist? 
• Answer: No. 

What else do I need to know?

• Because certain providers are "preferred," you can save money by using a PPO.
• Your plan can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
• If your plan gives you prior approval for a treatment, the approval must be valid for as long as the treatment’s medically necessary. Also, your plan can’t ask you to get additional approvals for that treatment. If you’re currently getting treatment and you switch to a new plan, you’ll have at least 90 days before the new plan can ask you to get a new prior approval for your ongoing treatment.

A Special Needs Plan (SNP) provides benefits and services to people with specific severe and chronic diseases, certain health care needs, or who also have 

Medicaid. SNPs include care coordination services and tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve.

SNPs are either HMO or PPO plan types, and cover the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. However, SNPs might also cover extra services for the special groups they serve. For example, if you have a severe condition, like cancer or congestive heart failure, and you need a hospital stay, an SNP may cover extra days in the hospital. You can only stay enrolled in an SNP if you continue to meet the special conditions of the plan.

You can join an SNP if you meet these requirements:

• You have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
• You live in the plan's service area. 
• You meet the eligibility requirements for one of the 3 types of SNPs:
  1. Dual Eligible SNP (D-SNP)
  2. Chronic Condition SNP (C-SNP)
  3. Institutional SNP (I-SNP)

What are the eligibility requirements for the 3 types of SNPs? 

1. Dual Eligible SNP (D-SNP) – You’re eligible for both Medicare and Medicaid. Some D-SNPs may provide Medicaid services in addition to Medicare services. D-SNPs contract with your state Medicaid program to help coordinate your Medicare and Medicaid benefits, depending on the state and your eligibility.
2. Chronic Condition SNP (C-SNP) – You have one or more of these severe or disabling chronic conditions:
   • Chronic alcohol and other dependence
   • Certain autoimmune disorders
   • Cancer (excluding pre-cancer conditions)
   • Certain cardiovascular disorders
   • Chronic heart failure
   • Dementia
   • Diabetes mellitus
   • End-stage liver disease
   • End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
   • Certain severe hematologic disorders
   • HIV/AIDS
   • Certain chronic lung disorders
   • Certain chronic and disabling mental health conditions
   • Certain neurologic disorders
   • Stroke

1. Institutional SNP (I-SNP) – You live in the community but need the level of care a facility offers, or you live (or are expected to live) for at least 90 days straight in a facility like a:
   • Nursing home
   • Intermediate care facility
   • Skilled nursing facility
   • Rehabilitation hospital
   • Long-term care hospital
   • Swing-bed hospital
   • Psychiatric hospital
   • Other facility that offers similar long-term, health care services and whose residents have similar needs and health care status as residents of the facilities listed above

Each year, different types of SNPs may be available in different parts of the country. Insurance companies decide where they’ll do business, so SNPs may not be everywhere in the U.S.

• Question: Do these plans charge a monthly premium?
• Answer: Varies by plan. Some plans may charge a premium, in addition to the monthly Part B (Medical Insurance) premium. However, if you have Medicare and Medicaid, most of the costs will be covered for you. Contact your Medicaid office for more information.
• Question: Do these plans offer Medicare drug coverage (Part D)?
• Answer: Yes. All SNPs must provide Medicare drug coverage (Part D).
• Question: Can I use any doctor or hospital that accepts Medicare for covered services?
• Answer: Varies by plan. Some SNPs require that you get your care and services from providers and facilities in the plan’s network (except for emergency care, out-of-area urgent care, or out-of-area dialysis). Some SNPs offer out-of-network coverage, so you can get services from any qualified provider or facility, but you’ll usually pay more.
• Question: Do I need to choose a primary care doctor?
• Answer: Varies by plan. If you have primary care doctor or provider you like, ask the plan if you can keep them.
• Question: Do I have to get a referral to see a specialist?
• Answer: Varies by plan. Referrals may be required for certain services but not others.

What else do I need to know?

• D-SNPs can help coordinate your benefits between Medicare and Medicaid.
• If you’re interested in an I-SNP, and live in a facility, check that the plan has providers that serve people where you live.
• C-SNPs can limit membership to a single chronic condition or a group of related chronic conditions.
• All SNPs use a care coordinator to help you stay healthy and develop a care plan with you.
• You can stay enrolled in a Medicare SNP only if you continue to meet the condition served by the plan. If you're losing your plan because you no longer meet the plan's conditions, you may be eligible for a Special Enrollment Period to join another plan. When can I join another plan? 
• Your plan can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
• If your plan gives you prior approval for a treatment, the approval must be valid for as long as the treatment’s medically necessary. Also, your plan can’t ask you to get additional approvals for that treatment. If you’re currently getting treatment and you switch to a new plan, you’ll have at least 90 days before the new plan can ask you to get a new prior approval for your ongoing treatment.
• Check with the plan you’re interested in for specific information.

An MSA is a type of consumer-directed 

Medicare Advantage Plan (Part C). These plans are similar to Health Savings Account (HSA) Plans like you’d get from an employer or the Marketplace. With MSA Plans, you can choose your health care services and providers (these plans usually don’t have a network of doctors, other health care providers, or hospitals).

Medicare MSA Plans have 2 parts:

MSAs combine a high-deductible insurance plan with a medical savings account to pay for your health care costs. You're responsible for handling the money in your account, including deciding whether to pay for health care services using your account funds or other funds you have.

1. High-deductible health plan: This is a special type of Medicare Advantage Plan. This type of plan only starts to cover your costs once you meet a high yearly 

deductible, which varies by plan. 

2. Medical savings account (MSA): This is a special type of savings account. Medicare gives the plan an amount of money each year for your health care expenses. This amount is based on your plan. The plan deposits money into your MSA account once at the beginning of each calendar year. Or, if you become entitled to Medicare in the middle of the year and join a Medicare MSA Plan at that time, the plan will deposit the money into your account the first month your coverage starts.

You can use this money to pay your Medicare-covered costs before you meet the plan’s deductible. You can access the money using a checking account or special debit or credit card your bank gives you. Check with your plan for details. The yearly deposit and yearly deductible are pro-rated based on when your enrollment begins. MSAs may also pay for some qualified medical expenses. 

Explore examples of a Medicare Savings Account Plans.

You can't join an MSA Plan if any of these apply to you:

• You have health coverage that would cover the Medicare MSA Plan deductible. This includes benefits under employer or union retiree plans.
• You joined another Medicare Advantage Plan.
• You get benefits from the U.S. Department of Defense (TRICARE) or the U.S. Department of Veterans Affairs.
• You're a retired Federal government employee and part of the Federal Health Benefits Program (FEHBP).
• You're eligible for Medicaid.
• You're currently getting hospice care.
• You live outside the U.S. more than 183 (total) days a year.

If you choose an MSA Plan then change your mind, you can cancel your enrollment by December 15 of the same year. You still only have until December 7 (during the Open Enrollment Period) to join another health or drug plan. After December 7 and up to December 15, you can only return to Original Medicare.

If you leave the MSA Plan before the end of the year, no more money will be added to your account. You’ll need to pay part of the most recent yearly deposit (based on the number of months left in the current calendar year) back to Medicare.

When can my Medicare MSA Plan cancel my enrollment?  

• Question: Do these plans charge a monthly premium? 
• Answer: No, but you must continue to pay your monthly Part B (Medical Insurance) premium.
• Question: Do these plans offer Medicare drug coverage (Part D)?
• Answer: No. If you join a Medicare MSA Plan and want Medicare drug coverage, you'll have to join a separate Medicare drug plan. Find drug plans in your area.
• Question: Can I use any doctor or hospital that accepts Medicare for covered services?
• Answer: Yes. You can go to any Medicare-approved doctor, other health care provider, or hospital that agrees to treat you and hasn't opted out of Medicare (for Medicare Part A and Part B items and services). MSA Plans usually don't have a network of doctor, other health care providers, or hospitals.
• Question: Do I need to choose a primary care doctor? 
• Answer: No. 
• Question: Do I have to get a referral to see a specialist?
• Answer: No.

What else do I need to know?

• MSA Plans cover the Medicare services that all Medicare Advantage Plans must cover. Some MSA plans also cover extra benefits like dental, vision, and hearing services. You may pay a premium for this extra coverage. Check with the plan you’re interested in for information on what extra benefits they offer, if any.
• Your plan can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
• If your plan gives you prior approval for a treatment, the approval must be valid for as long as the treatment’s medically necessary. Also, your plan can’t ask you to get additional approvals for that treatment. If you’re currently getting treatment and you switch to a new plan, you’ll have at least 90 days before the new plan can ask you to get a new prior approval for your ongoing treatment.
• During the time you're paying out of pocket for services before the deductible is met, doctors and other providers can't charge you more than the Medicare-approved amount.
• If you use all of the money in your account and you have additional health care costs, you'll have to pay for your Medicare-covered services out of pocket until you reach your plan's deductible.
• Money left in your account at the end of the year stays there, and may be used for health care costs in future years.

Get specific cost information about a plan type you’re interested in.

Can my surviving spouse or another beneficiary use money left in my account?

Any funds in your account that were deposited before the current calendar year are part of your estate and should be counted as gross income on your final tax return. Part of the most recent deposit (based on the number of months left in the current calendar year) will have to be paid back to Medicare.

If you name a beneficiary for your account who isn’t your spouse, the money in it after your death is counted toward that person's gross income when they file that year’s income tax return.

A PFFS is a type of Medicare Advantage Plan. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.  

• Question: Do these plans charge a monthly premium?
• Answer: Yes. These plans usually charge a premium, in addition to the monthly Part B (Medical Insurance) premium.
• Question: Do these plans offer Medicare drug coverage (Part D)?
• Answer: Sometimes. Prescription drugs may be covered. If your PFFS plan doesn’t offer drug coverage, you’ll need to join a separate Medicare drug plan (Part D) to get drug coverage. 
• Question: Can I use any doctor or hospital that accepts Medicare for covered services?
• Answer: You can go to any Medicare-approved provider or facility that accepts the plan’s payment terms, agrees to treat you, and hasn’t  opted out of Medicare (for Part A- and Part B-covered items and services). If you join a PFFS plan that has a network, you can see any of the network providers who have agreed to always treat plan members. You can also choose an out-of-network provider or facility who accepts the plan’s terms, but you may pay more. In an emergency, doctors, hospitals, and other providers must treat you.
• Question: Do I need to choose a primary care doctor?
• Answer: No.
• Question: Do I have to get a referral to see a specialist?
• Answer: No.

What else do I need to know?

• The plan decides how much you pay for services. The plan will tell you about your costs in the “Annual Notice of Change” and “Evidence of Coverage” that it sends each year.
• You’ll need to show your plan membership ID card each time you go to a health care provider. Your provider can choose at every visit whether to accept your plan’s terms and conditions of payment. You can’t use your red, white, and blue Medicare card to get heath care because Original Medicare won’t pay for your health care while you’re in a PFFS plan. Keep your Medicare card in a safe place in case you return to Original Medicare in the future.
• Your plan can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
• If your plan gives you prior approval for a treatment, the approval must be valid for as long as the treatment’s medically necessary. Also, your plan can’t ask you to get additional approvals for that treatment. If you’re currently getting treatment and you switch to a new plan, you’ll have at least 90 days before the new plan can ask you to get a new prior approval for your ongoing treatment.
• Check with the plan you’re interested in for specific information.

Before joining a Medicare Advantage Plan
Talk to your employer, union, or other benefits administrator about their rules before you join a Medicare Advantage Plan. In some cases, joining a Medicare Advantage Plan might cause you to lose your employer or union coverage. If you drop or lose employer or union coverage for yourself, you may also lose coverage for your spouse and dependents. You may not be able to get this coverage back.

Insurance companies can decide if a plan will be available to everyone with Medicare in a state, or only in certain counties. Insurance companies may also offer more than one plan in an area, with different benefits and costs. Each year, insurance companies can decide to join or leave Medicare.

If a plan decides to stop participating in Medicare, you’ll have to join another Medicare health plan or return to Original Medicare.

A Medicare Advantage Plan can disenroll you for several reasons, like if you move outside the plan's service area, lose Medicare or Medicaid eligibility, join a drug plan (in some cases), or if the plan's contract with Medicare ends. In these situations, there's a grace period when you'll be eligible for a Special Enrollment Period. It's important to review your options at this time to make sure you continue to have the Medicare health and drug coverage you want.