Medicare Advantage Health Maintenance Organization (HMO) plans provide networks of doctors, hospitals, and other healthcare professionals that policyholders are required to use.
Exceptions to this rule include emergency care, out-of-area urgent care, and temporary out-of-area dialysis.
Medicare Advantage Preferred Provider Organization (PPO) plans provide networks of doctors, hospitals, and other healthcare professionals and facilities. Policyholders are not required to use in-network providers, but while out-of-network providers are covered, they generally come at a higher cost.
Medicare Advantage Special Needs Plans (SNPs) cover the same Medicare Parts A & B benefits that all Medicare Advantage plans cover. They may also cover extra services for the special groups they serve, such as care coordination services, tailored benefits and provider choices, and specific prescription drugs. SNPs may be structured either as an HMO plan or a PPO plan, and are only available to those with specific conditions, certain healthcare needs, or combined Medicare and Medicaid eligibility.
| Coverage | HMO Plans | PPO Plans | SNPs |
| Charges monthly premium | Yes | Yes | Yes |
| Covers prescription drugs | Sometimes | Sometimes | Yes |
| Allows out-of-network coverage | Sometimes | Yes | Sometimes |
| Requires primary care physician | Sometimes | No | Sometimes |
| Requires referrals for specialist care | Yes | No | Sometimes |
*Available on some Medicare Advantage plans
How do I enroll in Medicare Advantage?
To enroll in a Medicare Advantage plan, you must be eligible for Medicare coverage. Medicare is generally available to anyone in the United States over the age of 65; some conditions may qualify you for Medicare coverage before reaching that age:
To enroll in Medicare Advantage (Part C) coverage, use our Medicare plan comparison tool to find the plan(s) that work best for you and enroll online or over the phone during a qualifying enrollment period:
When do I enroll in Medicare Advantage?
You can enroll in a Medicare Advantage plan during a qualified Medicare Enrollment Period. Here are a few of the most common times of year to enroll in, or change, your Medicare Part C coverage:
Who is eligible for Medicare Advantage?
Medicare Advantage plans are available to anyone eligible for Original Medicare (Medicare Parts A & B, coverage provided by the federal government). Medicare is available to those who qualify by age or by special qualifying conditions.
How do I choose a Medicare Advantage plan?
Medicare Advantage plans all provide comprehensive coverage of the same benefits you get from Original Medicare (Parts A & B), which means any Medicare Advantage plan you choose will provide hospital coverage, hospice coverage, medical insurance, and preventative care. Medicare Advantage plans also offer additional benefits that vary by plan and may include vision coverage, dental coverage, health and wellness programs, and gym memberships.
Use our online tool or speak to an agent to compare plans available in your area. Choose the plan that offers the additional benefits that most fit your needs, at the right budget for you, during an appropriate enrollment period.
Learn about the two Medicare enrollment periods that run from January through March.
When is the Medicare Annual Enrollment Period? Get answers to this and other AEP-related questions.
Get fast facts about Medicare Enrollment, including when you qualify and when to enroll.
