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A Medicare Advantage planâalso known as Part Câis an alternative to Original Medicare offered by a private insurance company. These plans combine Medicare Part A (hospital coverage) and Part B (medical coverage), and many also include Part D prescription drug coverage, all in one plan.
How does Medicare Advantage differ from Original Medicare?
Medicare Advantage plans are run by private insurers and typically use provider networks, such as HMOs or PPOs, while Original Medicare is run by the federal government and allows broader provider choice. Advantage plans often include benefits Original Medicare doesnât coverâsuch as vision, dental, or hearing careâbut may require referrals, prior authorization, or in-network providers for full coverage.
What types of Medicare Advantage plans are available?
The most common Medicare Advantage plans are health maintenance organization (HMO) plans and preferred provider organization (PPO) plans. Other options include private fee-for-service (PFFS) plans, special needs plans (SNPs) for people with specific health conditions, and Medicare medical savings account (MSA) plans, which pair a high-deductible plan with a Medicare-funded savings account.
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Your Advantage plan might be PPO, HMO, PFFS, or SNP.
Medicare Advantage plans are offered by private health insurers and provide an alternative to traditional Medicare. During the annual enrollment period each fall, major companies like UnitedHealth Group (UHC), Humana (HUM), Aetna, and Cigna (CI) promote a wide array of plans, each with different coverage and network options.
For many Medicare beneficiaries, the sheer number of choices and types of plansâsuch as HMOs, PPOs, and special needs plansâcan feel overwhelming as they weigh their health care needs, preferred doctors, and household budgets. With so many options, you may wonder how Medicare Advantage plans differ from traditional Medicare and which Advantage plan best suits your health care needs and budget.
Note: The annual election period (AEP) runs October 15âDecember 7 each year; coverage elected during AEP begins on January 1 of the following year. (For one-time changes after your initial enrollment, the Medicare Advantage open enrollment period runs from January 1âMarch 31.)
Key Points
The number of seniors enrolled in Medicare Advantage has grown steadily over the past 20 years.
Advantage plans (known as Part C) effectively bundle Medicare Part A, Part B, and sometimes Part D into one plan, making them easier for many beneficiaries to understand.
Advantage plans can offer added benefits that Original Medicare doesnât provide, including dental coverage and vision care.
The share of Medicare beneficiaries enrolled in Medicare Advantage has grown steadily over the past 20 years, while enrollment in Original Medicare has declined. In 2025, more than 34 million U.S. residents were enrolled in a Medicare Advantage plan, accounting for 54%âmore than halfâof all Medicare recipients, according to KFF, the health policy organization formerly known as the Kaiser Family Foundation. Thatâs a huge jump from 19% in 2007. Medicare Advantage enrollment crossed the 50% threshold in 2024, and participants in these plans now outnumber those in Original Medicare.
Types of Medicare Advantage plans: HMO, PPO, PFFS, and SNP
But Medicare Advantage plansâalso known as Part Câhavenât gained in popularity on the strength of marketing alone. These plans effectively bundle Part A (hospitalization), Part B (medical insurance, including doctor visits), and usually Part D (drug coverage) into one plan, making it easier for many people to understand. As of 2026, nearly all Medicare Advantage plans offer at least one supplemental benefit not covered by Original Medicare, such as vision, dental, or hearing coverage.
And those enrolled in Advantage plans donât need to purchase additional Medicare Supplement insuranceâin fact, if you have an Advantage plan, insurance companies arenât allowed to sell you a supplemental, or Medigap, policy.
The ABCs (and Part D) of Medicare
Unsure what each part of Medicare covers? Britannica Moneyâs Medicare overview explains what Parts A, B, C, and D offerâfrom hospitalization to prescription drug coverage.
Unlike Original Medicare, there are numerous insurance companies in each state that offer a variety of Advantage plan options. The many alternatives can become confusing, so a bit of research is necessaryâperhaps with the help of a Medicare consultantâto sort through the various choices.
If youâre comfortable navigating a variety of plan optionsâincluding some that may limit your choice of doctorsâa Medicare Advantage plan could be a good alternative to traditional Medicare. Medicare Advantage offers four basic plan types, each with different coverage and network rules.
If youâre in an HMO plan, youâre limited to doctors, health professionals, and hospitals within the network (unless youâre seeking emergency care on vacation, for example). Some plans offer an HMO point-of-service (HMO-POS) option that allows additional out-of-network flexibility in exchange for a higher co-pay or coinsurance.
Prescription drugs are usually covered in HMO plans. In most cases (aside from annual screenings, such as mammograms), youâll have to get a referral from a primary care physician to see a specialist. And youâll probably need prior authorization for certain services and surgeries that arenât emergencies.
HMO plans often require you to adhere to specific rules for prior authorization and network referrals to ensure coverage for a service or procedure.
2. Preferred provider organization (PPO) plans
PPO plans offer more freedom than HMO plans. As with HMOs, a PPO plan provides a network of doctors, other health care professionals, and hospitals. But you also have the option of using out-of-network providers for covered servicesâtypically at a higher cost. Youâre always covered for emergency and urgent care.
Just as Original Medicare keeps prescription drug coverage separate and optional (under Part D), not all Medicare Advantage PPO plans automatically offer drug coverage. If you think you need it, make sure your plan covers it.
With a PPO plan, you may not need a referral from a primary care doctor to see a specialist. But out-of-network specialists generally cost more than in-network ones, and your plan might still require prior authorization for nonemergency procedures.
3. Private fee-for-service (PFFS) plans
Medicare Advantage also allows private fee-for-service (PFFS) plans, in which an insurance company agrees to a pay set amount for each service or procedure. Typically, a PFFS plan offers a list of costs for each procedure along with providers in your area that are willing to treat you at that price (minus a co-pay).
PFFS plans are generally more expensive and less popular than HMOs or PPOs, but referrals or prior authorization for treatment typically arenât required.
4. Special needs plans (SNPs)
These plans are designed for people with specific types of health care needs, such as treatment for cancer, diabetes, alcoholism, dementia, or HIV/AIDS. SNPs typically cover doctor visits, hospital stays, medications, and other services tailored to these specific needsâincluding access to related specialists.
Medicare medical savings account (MSA) plans
Some Medicare Advantage plans offer a Medicare medical savings account (MSA) option, which combines a high-deductible health plan with a savings account funded solely by Medicare. Medicare deposits a set amount into the MSA each year, and these funds can be used for qualified medical expenses. Unlike health savings accounts (HSAs), you cannot make personal contributions to a Medicare MSA, so the funds are limited to what Medicare provides.
Medicare MSA vs. HSA
When you choose a Medicare medical savings account (MSA), youâre enrolling in a Medicare Advantage plan that combines a health savings account with a high-deductible health plan as one package. Only Medicare funds the account (personal contributions arenât allowed).
A health savings account (HSA) is different. Itâs a separate account you can pair with a high-deductible health plan, funded by your own contributions (typically through payroll deductions) and, in some cases, contributions from your employer. These funds can be used for qualified out-of-pocket health care expenses.
MSA plans are designed for consumers comfortable with a higher deductible and looking to save on monthly premiums. Because MSAs do not include prescription drug coverage, a separate Part D plan is required, and the high deductible means youâre on the hook for expenses until the threshold is met.
How to enroll in a Medicare Advantage plan
If youâre looking to compare Medicare Advantage plans in your area, the plan finder at Medicare.gov can help.
You must already have Medicare Part A and Part B coverage to enroll in a Medicare Advantage plan.
Once you choose a plan, you can often enroll directly through the planâs website, by phone, or with a paper form. Some plans also allow you to enroll through the Medicare website, which will guide you to the insurer for finalizing the process. Youâll need to supply your government-issued Medicare number and the date your Part A and Part B coverage started.
The bottom line
Going the Medicare Advantage route introduces you to many choices that arenât available to an Original Medicare beneficiary. For some, the challenge of picking the right plan from a sea of choices can be overwhelming.
But if youâre willing to do the research, perhaps with the help of a trusted loved one or Medicare professional, a Medicare Advantage plan that provides added services at a reasonable price could be the right solution for you.
