While the majority of people with Medicare get their health coverage from Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. , some choose to get their benefits from a Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plan, also known as a Medicare private health plan or Part C. MA Plans contract with the federal government and are paid a fixed amount per person to provide Medicare benefits.
The most common types of MA Plan are:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Private Fee-For-Service (PFFS)
You may also see:
- Special Needs Plans (SNPs)
- Provider Sponsored Organizations (PSOs)
- Medical Savings Accounts (MSAs)
Remember, you still have Medicare if you enroll in an MA Plan. This means that you likely pay a monthly for Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. (and a Part A Part A, also known as hospital insurance, is the part of Medicare that covers most medically necessary hospital inpatient care, skilled nursing facility (SNF) care, home health care, and hospice care. premium, if you have one). If you are enrolled in an MA Plan, you should receive the same benefits offered by Original Medicare. Keep in mind that your MA Plan may apply different rules, costs, and restrictions, which can affect how and when you receive care. They may also offer certain benefits that Medicare does not cover, such as dental and vision care, caregiver A caregiver is anyone who provides help and support to someone who is either temporarily or permanently unable to function or someone who can function but not optimally. Most caregivers are unpaid, and are often a family member, friend, or neighbor. Formal caregivers are paid care providers or volunteers associated with a service system. counseling and training, and certain in-home support like housekeeping. Not all MA Plans cover additional benefits, so check with a plan directly to learn what benefits it covers.
All Medicare Advantage Plans must include a limit on your out-of-pocket expenses for Part A and B services. For example, the maximum out-of-pocket cost for HMO plans in 2025 is $9,350. These limits tend to be high. In addition, while plans cannot charge higher copayments or coinsurances than Original Medicare for certain services, like chemotherapy and dialysis Dialysis is the treatment used to artificially cleanse your blood of toxins when your kidneys no longer work. , they can charge higher cost-sharing Cost-sharing is the portion of medical care costs that you pay yourself, such as a copayment, coinsurance, or deductible, if you have health insurance coverage. See also: Out-of-Pocket Costs. for other services.
Remember: MA Plans may have different:
- Networks of providers
- Coverage rules
- Premiums (in addition to the Part B premium)
- Cost-sharing for covered services
Even plans of the same type offered by different companies may have different rules, so you should always check with a plan directly to find out how its coverage works.
You can join an MA Plan if:
- You have Medicare Parts A and B
- And, you live in the plan’s service area The service area is the geographic area where a Medicare Advantage Plan or Part D plan provides medical services to its members. In many plans, the service area is where your network of providers is located.
Many Medicare Advantage Plans also offer prescription drug coverage ( Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. ). If you join an MSA plan or a PFFS plan without drug coverage, you can enroll in a stand-alone Part D plan. Remember that people with Original Medicare who want Part D coverage also enroll in a stand-alone Part D plan.
If you have health coverage from your union or employer (current or former) when you become eligible for Medicare, you may automatically be enrolled in an MA Plan that they sponsor. You have the choice to stay with this plan, switch to Original Medicare, or enroll in a different MA Plan. Be aware that if you switch to Original Medicare or enroll in a different MA Plan, your employer or union could terminate or reduce your health benefits, the health benefits of your dependents, and any other benefits you get from your company. Talk to your employer/union and your plan before making changes to find out how your health benefits and other benefits may be affected.