Medicare Advantage Plans (Part C)

Fact Checked

Medicare Advantage Plans (also known as MA or Part C) are the alternative way to get your Original Medicare Part A and Part B coverage. MA Plans are administered by Medicare-approved private insurance companies who are required to abide by Medicare’s rules.

MA plans typically offer additional benefits beyond Original Medicare (Medicare Part A and B), such as prescription drug coverage (Part D), dental, hearing and vision services, and more. All medical insurance coverage and related services are bundled together in one plan, thus eliminating the need for Medicare supplement insurance. There are different types of MA Plans to consider. Read below to understand which type of MA plans may offer the best fit for you.

The Best Medicare Advantage Plans

MA plans include a variety of benefits. Join a MA Plan if you:

  • Prefer a Medicare insurance plan that bundles all medical insurance coverage, prescription drug, and other benefits, like vision, hearing, and dental
  • Are willing to receive your benefits from a network of health care providers to keep your costs as low as possible
  • Don’t want to risk paying uncapped out-of-pocket costs of Original Medicare or having  to purchase a Medigap policy

How We Review Medicare Advantage Plans

+

Financial strength

Financial strength is based on the insurance company’s A.M. Best financial strength rating. A.M. Best is a credit rating agency specializing in the insurance industry, which rates an insurer’s ability to meet ongoing obligations.

+

Customer satisfaction

Customer satisfaction takes into account the insurer’s Better Business Bureau (BBB), National Committee for Quality Assurance (NCQA), and Consumer Affairs ratings, calculated using customer complaints and satisfaction rankings.

+

Value

Value calculates an insurer’s overall value based on monthly premium, annual deductible, visit cost, and annual maximum out-of-pocket cost.

+

Coverage

Coverage considers the insurer’s availability of coverages, plan types, and network size.

Insurance company Medicare Average Rating A.M. Best Rating BBB Rating Coverage Area
Anthem: Best for affordable MA plans

Anthem Logo

4 to 4.5 stars A A+ 14 states
Aetna: Best for $0 premiums and affordable copays

Aetna Logo

4 stars A- to B++ A+ 46 states
Blue Cross Blue Shield: Best for coverage for out-of-state travel

Blue Cross Blue Shield Logo

3.8 stars A to B++ A+ All 50 states, Puerto Rico
Cigna: Best for lowest out-of-pocket costs

Cigna Logo

4 stars A Not rated 26 states
Highmark: Best for covering a broad range of telehealth services

Highmark Logo

4.5 stars A A- Pennsylvania, West Virginia, Delaware
Humana: Best for coverage in all 50 states

Humana Logo

4 stars A A- All 50 states
Kaiser: Best for coordinated care

Kaiser Logo

5 stars A A- Eight states and Washington, D.C.
United Healthcare: Best for the largest network of doctors and specialists

United Healthcare Logo

3.5 stars A- A- Every state except Alaska

Anthem: Best for Affordable Medicare Advantage Plans

Anthem Logo

Company Overview 
Company founded 2004
Coverage area 14 states
A.M. Best rating A
BBB rating A+
NCQA accreditation No
NCQA rating N/A
Consumer Affairs rating 3.9
J.D. Power ranking 6
Medicare Rating Financial Stability Customer Satisfaction Coverage
Anthem’s MA Plans have an overall quality rating ranging from 4 to 4.5 stars from the Centers for Medicare & Medicaid Services (CMS). Anthem’s PPO Plans have the highest rating of 4.5. Anthem is rated A (Excellent) by A.M. Best. Anthem has an A+ BBB rating and 3.9-star Consumer Affairs rating. While Anthem has many MA options, it is only available in 14 states. But the plans offer prescription drug coverage, vision, dental, hearing, wellness benefits including free gym memberships, medical transportation.
The bottom line: Anthem offers competitive MA Plans in terms of features, affordability, and member satisfaction, although their geographic availability is limited.

Anthem was founded in 2004 and is headquartered in Indianapolis, Indiana. It is one of the largest health insurance providers in the country and offers a range of Blue Cross Blue Shield MA Plans in 14 states. Most plans include prescription drug coverage.

A benefit of Anthem is that its range of Medicare plans allow you to choose an option that is affordable for you. That includes plans with no premiums or deductibles, which is why we rate Anthem as the most affordable MA plan provider.

Consumers who use Anthem’s plans appreciate that televisits are covered and there is 24/7 nursing and pharmacy support. These Essential Extras vary among plans and can include fitness tracking, a personal home helper, transportation, and meal delivery. The more extras you get, the higher the cost.

Reviewers say access to care and affordability are highlights of Anthem plans. But the company does not do as well as others in coverage for health conditions and medications. Anthem offers plans with wellness benefits like free gym memberships, though this is typical among the plans we rated.

As for stability, Anthem earned a Financial Strength rating of A (Excellent) from A.M. Best. A downfall is that Anthem is not rated by NCQA while others are.

Why Anthem is best for affordable Medicare Advantage Plans

We rated Anthem as best for Affordable MAe Plans because many plans have no premiums or deductibles, and the breadth of options allows you to select a plan that suits your budget. Also beneficial: Many include additional services and benefits like prescription drug coverage, dental, vision, hearing, and fitness memberships while still keeping fees low.

Pros and cons of Anthem Medicare plans

What we like about Anthem MA Plans: The drawbacks of Anthem MA Plans:
  • Affordable plans with extra benefits
  • Televisits covered, including 24/7 nursing and pharmacy support
  • Variety of HMO and PPO plans available
  • Only available in 14 states
  • Not rated by NCQA

Who should consider Anthem Medicare Advantage Plans?

  • Medicare beneficiaries who want extra benefits like 24/7 nursing and pharmacy support.
  • Those who are looking for a variety of HMO and PPO plans so they can choose in- or out-of-network providers without exorbitant costs.
  • Beneficiaries who want to choose among plans that include no premiums or deductibles.

What do Anthem Medicare Advantage Plans cover?

Most Anthem Medicare Advantage Plans include:

  • Prescription drug coverage
  • Vision
  • Dental
  • Hearing
  • Wellness benefits, such as free gym memberships
  • Medical transportation (some plans)
  • Wellness over-the-counter medications (some plans)
  • Personal emergency response system

Blue Cross Blue Shield: Best for Coverage for Out-of-State Travel

Blue Cross Blue Shield Logo

Company Overview 
Company founded 1929
Coverage area Every state and Puerto Rico
A.M. Best rating A to B++
BBB rating A+
NCQA accreditation Yes
NCQA rating 2.5 to 4.5 stars
Consumer Affairs rating 3.5 stars
J.D. Power ranking 6 and 9 out of 10
Medicare Rating Financial Stability Customer Satisfaction Coverage
BCBS MA Plans have an average CMS satisfaction rating of 3.8 stars. BCBS is rated A to B++ by A.M. Best. Aetna has an A+ BBB rating and a 3.5-star rating on Consumer Affairs. Blue Cross Blue Shield has a wide coverage area across the country and comprehensive benefits.
The bottom line: Blue Cross Blue Shield is a household name in health care with good reason for seniors to trust the company for their Medicare needs.

Blue Cross Blue Shield has grown since its founding to include 36 regional companies with coverage in every state including Puerto Rico. This is a standout quality of the provider since most insurance companies we rated do not have such expansive coverage. But what really sets apart the plans are the choice and flexibility you gain. For example, you can elect out-of-state coverage when traveling and this is not an option with other companies we rated.

Premiums are lower than some other companies. For example, two of the five plans we reviewed have a $0 monthly premium, and the highest premium is $190.15. That said, the annual maximum out-of-pocket expense is higher than others, with one of Blue Cross Blue Shield’s MAe plans maxing out at $7,550 in network.

As for what plan users think about the coverage, opinions vary based on region since every branch is a separate company. So, there is some inconsistency. However, the company is stable and has been in business since 1929, when it started as the first health insurance plan for teachers in Dallas, Texas. It has an A.M. Best Financial Strength rating of A to B++

Overall, you can depend on Blue Cross Blue Shield for coverage that allows you choice among providers and access to benefits you can’t get with others, particularly out-of–state insurance for travel.

Why Blue Cross Blue Shield is best for coverage for out-of-state travel

Other insurance companies we reviewed do not offer the benefit of coverage for out-of-state travel, and this can be an important feature for Medicare beneficiaries. If you are visiting with family, friends, or spending some extended time in another state of which you are not a resident, you might want the peace of mind knowing that you can access health care benefits when and where you need them.

Pros and cons of Blue Cross Blue Shield Medicare plans

What we like about Blue Cross Blue Shield MA Plans: The drawbacks of Blue Cross Blue Shield MA Plans:
  • Low premiums with optional coverage upgrades for MA  Plus
  • Optional out-of-state coverage when traveling
  • Reputable company with a large provider network
  • Coverage and plans vary from state to state
  • Plan details can be confusing

Who should consider Blue Cross Blue Shield Medicare Advantage Plans?

  • Those who travel often and want MA coverage available in other states.
  • Medicare beneficiaries who value a $0 monthly premium and don’t mind a larger out-of-pocket maximum.
  • Anyone who wants optional coverage upgrades.

What do Blue Cross Blue Shield Medicare Advantage Plans cover?

Most Blue Cross Blue Shield Medicare Advantage Plans include:

  • Prescription drug coverage
  • Vision
  • Dental
  • Hearing
  • Wellness benefits, such as free gym memberships
  • Medical transportation (some plans)
  • Wellness over-the-counter medications (some plans)

Cigna: Best for Lowest Out-of-Pocket Costs

Cigna Logo

Company Overview 
Company founded 1792
Coverage area 26 states
A.M. Best rating A
BBB rating Not rated
NCQA accreditation Yes
NCQA rating 2.5 to 4 stars
Consumer Affairs rating 3.4 stars
J.D. Power ranking 7 out of 10
Medicare Rating Financial Stability Customer Satisfaction Coverage
Cigna MA Plans have an average CMS satisfaction rating of 4 stars. Cigna is rated A by A.M. Best. Cigna has a 3.4-star rating on Consumer Affairs. Coverage is available in 26 states with benefits including vision, dental, and hearing.
The bottom line: While Cigna MA Plans are not yet available in all states, those who have access can take advantage of the low copays and broad range of services they offer.

Cigna is one of the most affordable MA plan providers and you won’t sacrifice benefits with its plans. Many plans offer $0 copay with virtual care when visiting a primary care physician. Plus, you get dental, vision, and hearing coverage, along with behavioral health care and preventive care.

Because the network has grown beyond HMOs, Cigna now offers PPO plans that give you the flexibility to choose an in- or out-of-network provider. Other large companies like UnitedHealthcare only offer HMOs.

The real standout is the lower out-of-pocket expense you’ll pay with Cigna plans. For example, annual maximums range from $3,150 to $4,400 in network compared to others that can go up to $7,550. And while plans like Kaiser offer comparably low out-of-pocket maximums, your coverage is limited to eight states and the company only offers HMOs.

Customer complaints are related to customer service, but CMS acknowledges Cigna for preventive services and chronic condition management. And unlike some reviews, CMS gives Cigna high ratings for customer satisfaction.

Why Cigna is best for lowest out-of-pocket costs

Because of Cigna’s $0 out-of-pocket plans and lower out-of-pocket maximums than competing plans, its affordability earns accolades.

Pros and cons of Cigna Medicare plans

What we like about Cigna MA Plans: The drawbacks of Cigna MA Plans:
  • $0 copay when using virtual care or visit your primary care physician
  • Recent network growth
  • Behavioral health care and preventive care
  • Only available in 26 states
  • Not many PPO options available

Who should consider Cigna Medicare Advantage Plans?

  • Those who value primary care and want $0 copays for those visits.
  • Medicare beneficiaries that want to explore HMO and now-available PPO plans from Cigna.
  • Anyone wanting benefits like behavioral health care.

What do Cigna Medicare Advantage Plans cover?

Most Unitedhealthcare Medicare Advantage Plans include:

  • Prescription drug coverage
  • Vision
  • Dental
  • Hearing
  • Wellness benefits, such as free gym memberships
  • Medical transportation (some plans)
  • Wellness over-the-counter medications (some plans)

Highmark: Best for Covering a Broad Range of Telehealth Services

Highmark Logo

Company Overview 
Company founded 1996
Coverage area
  • Pennsylvania
  • West Virginia
  • Delaware
A.M. Best rating A
BBB rating A-
NCQA accreditation Yes
NCQA rating 2.5 to 4.5 stars
Consumer Affairs rating 2.5 stars
J.D. Power ranking 2 out of 10
Medicare Rating Financial Stability Customer Satisfaction Coverage
Highmark MA Plans have an average CMS satisfaction rating of 4.5 stars. Highmark is rated A by A.M. Best. Highmark has an A- rating on BBB and a 2.5-star rating on Consumer Affairs. Coverage is limited to Pennsylvania, West Virginia, and Delaware with benefits including prescription drug coverage, vision, dental, hearing, and wellness.
The bottom line: Highmark administers MA Plans with quality coverage for preventative care, but reviews are mixed on its treatment coverage.

A standout quality of Highmark is its coverage for telehealth services, which is not something offered by other providers we reviewed. Or, options are limited. For example, Humana waives out-of-pocket costs for telemedicine only via MDLIVE. A downside of Highmark is its limited coverage area in three states.

Overall, Highmark offers plans with comprehensive preventive services, but it gets low ratings for coverage for hospital stays, physical therapy, and home health care. While plans have no annual deductible or copay to see primary care doctors (a reason for positive preventive service reviews), there are limited plan options.

NCQA gives Highmark a 1.5 to 4.5 star rating, so there is some inconsistency there. But BBB gives the company an A+.

Why Highmark is best for covering a broad range of telehealth services

Highmark’s telehealth coverage is more comprehensive than others and not limited to one platform.

Pros and cons of Highmark Medicare plans

What we like about Highmark MA Plans: The drawbacks of Highmark MA Plans:
  • No annual deductibles
  • No copay to see a primary care doctor
  • Covers a broad range of telehealth services
  • Only available in three states and not all regions have every plan
  • Limited plan options
  • Only PPOs are available

Who should consider Highmark Medicare Advantage Plans?

  • Medicare beneficiaries that want to take advantage of an array of telehealth services that are covered under its plans.
  • Those who prefer a PPO. No HMOs are available from Highmark.
  • Anyone who values a $0 copay for primary care provider visits.

What do Highmark Medicare Advantage Plans cover?

Most Highmark Medicare Advantage Plans include:

  • Prescription drug coverage
  • Vision
  • Dental
  • Hearing
  • Wellness benefits, such as free gym memberships
  • Medical transportation (some plans)
  • Wellness over-the-counter medications (some plans)

Humana: Best for Coverage in All 50 States

Company Overview 
Company founded 1961
Coverage area 50 states
A.M. Best rating A
BBB rating A-
NCQA accreditation Yes
NCQA rating 4.5 to 5 stars
Consumer Affairs rating 4
J.D. Power ranking 4 out of 10
Medicare Rating Financial Stability Customer Satisfaction Coverage
Humana MA Plans have an average CMS satisfaction rating of 4 stars. Humana is rated A by A.M. Best. Humana has an A- rating on BBB and a 4-star rating on Consumer Affairs. No matter what state you live in, you can access Humana MA coverage.
The bottom line: Humana, one of the leading health insurance companies in the United States, offers a variety of MA Plans (Part C), including HMOs, PPOs, SNPs, and PFFS plans. Plan availability may vary by region.

Humana has coverage in all 50 states, though plans vary depending on the region. Some states might only offer a Part D Prescription Drug plan. Some of the ancillary services members can access in plans include consultation with dieticians and free gym memberships. Also, you can choose among four different plan types depending on where you live: HMOs, PPOs, PFFS plans, and SNPs. Other companies we reviewed might offer just HMOs, or HMOs and PPOs.

Humana’s telemedicine services include the in-network provider MDLIVE for online or phone consults for physician and behavioral health issues. The company will waive-out-of-pocket costs. This is a standout benefit, but not quite as robust as Highmark’s broad coverage for telehealth services. That said, Highmark is only available in three states and Humana is nationwide.

Overall, Humana gets positive reviews from customers, with a 4-star rating from CMS. The only other companies that CMS rated higher are Anthem, Providence, Humana, and Kaiser.

Why Humana is best for coverage in all 50 states

Humana is only one of two companies we ranked that offer coverage nationwide that also provides a telemedicine benefit and options that include HMOs, PPOs, SNPs, and PFFS plans.

Pros and cons of Humana Medicare plans

What we like about Humana MA Plans: The drawbacks of Humana MA Plans:
  • Large selection of plan offerings
  • High review scores
  • Out-of-pocket costs waive for telemedicine via MDLIVE
  • Choices and costs can be confusing
  • Non-contracted providers can refuse to treat you unless it’s an emergency

Who should consider Humana Medicare Advantage Plans?

  • Medicare beneficiaries interested in ancillary services like consultation with dieticians and free gym memberships.
  • Those who consider using telemedicine can access MDLIVE for no out-of-pocket cost.
  • Anyone who will consistently stick with contracted providers, since those not under contract might not treat you unless it is an emergency.

What do Humana Medicare Advantage Plans cover?

Humana Advantage Plans may include extra coverage for:

  • Dental
  • Hearing
  • Vision care

Kaiser: Best for Coordinated Care

Kaiser Logo

Company Overview 
Company founded 1945
Coverage area
  • Colorado
  • California
  • Hawaii
  • Washington
  • Georgia
  • Virginia
  • Maryland
  • Oregon
  • Washington, D.C.
A.M. Best rating A
BBB rating A-
NCQA accreditation Yes
NCQA rating 4.5 to 5 stars
Consumer Affairs rating 4
J.D. Power ranking 1 out of 10
Medicare Rating Financial Stability Customer Satisfaction Coverage
Kaiser MA Plans have an average CMS satisfaction rating of 5 stars. Kaiser is rated A by A.M. Best. Kaiser has an A- rating on BBB and a 4-star rating on Consumer Affairs. Eight states and Washington, D.C.
The bottom line: Kaiser Permanente offers MA Plans that emphasize coordinated care, but options are limited to eight states.

Kaiser is an outstanding provider with financial stability, ranking 1st out of 10 by J.D. Power Associates. Plans emphasize coordinated care, which make sense since the company has several subsidies that work to provide affordable care. The Foundation Health PLan manages insurance, while the Kaiser Foundation Hospitals and Permanente Medical Groups provide medical care.

If you go with Kaiser’s MA Plans, you’ll get turn-key access to Kaiser’s hospital, pharmacy, and doctor services that all accept Kaiser’s insurance. The downside is, Kaiser only offers HMOs which require using in-network Kaiser providers.

With Kaiser plans, there is no annual deductible, low premiums if you select the base plan, and you can get injectable Part D vaccines. The company gets standout customer ratings and accolades from third parties like NCQA, which gives Colorado and California plans 5 stars and others 4.5 stars. This puts Kaiser in the Higher Performance category.

That said, you can only get a Kaiser MA plan in eight states. So while it has a 5-star rating from CMS, most of the country cannot access its plans. Still, the coordinated care model is notable and makes Kaiser shine in the MA arena.

Why Kaiser is best for coordinated care

Kaiser is an all-encompassing organization that has an insurance side of the business and network of Kaiser Foundation Hospitals and Permanente Medical Groups so members get coordinated care for hospital services, preventive medicine, and pharmacy.

Pros and cons of Kaiser Medicare plans

What we like about Kaiser MA Plans: The drawbacks of Kaiser MA Plans:
  • High performance ratings and customer reviews
  • Low premiums for the base plan
  • No annual deductible
  • Injectable Part D vaccines
  • Coverage limited to eight states and Washington D.C.
  • Only HMO options are available

Who should consider Kaiser Medicare Advantage Plans?

  • Medicare beneficiaries that want connected care with an all-encompassing insurance and medical group.
  • Those seeking low premiums and willing to elect the base plan for this option.
  • Potential members who are willing to just use Kaiser network providers.

What do Kaiser Medicare Advantage Plans cover?

Kaiser Permanente Medicare Advantage Plans also include these services not typically covered by Original Medicare:

  • Prescription drug coverage (mail-order pharmacy included)
  • Vision
  • Dental
  • Hearing
  • Wellness benefits, such as free gym memberships
  • Medical transportation
  • Wellness over-the-counter medications
  • Worldwide emergency
  • Telehealth

UnitedHealthcare: Best for Largest Network of Doctors and Specialists

United Healthcare Logo

Company Overview 
Company founded 1977
Coverage area Every state except Alaska
A.M. Best rating A-
BBB rating A-
NCQA accreditation Yes
NCQA rating 4 stars
Consumer Affairs rating 3.8 stars
J.D. Power ranking 4 out of 10
Medicare Rating Financial Stability Customer Satisfaction Coverage
UHC MA Plans have an average CMS satisfaction rating of 3.5 stars. UHC is rated A- by A.M. Best. UHC has an A- rating on BBB. Every state except Alaska
The bottom line: UnitedHealthcare plans are widely available across the United States, but some options may exceed your budget allowance for health care.

UnitedHealthcare is available in every state except Alaska and earns an above average ranking of 3.5 stars from CMS. UnitedHealthcare only provides HMO MA plans, which means you must stay in-network. This could be a downside if you want some flexibility to use out-of-network providers.

With HMOs, you also have to establish a primary care provider and get referrals for specialists, which is not the case with PPOs.

Most plans offer $0 annual deductibles, but the annual out-of-pocket maximums are higher than others. For instance, one in-network out-of-pocket max is $7,550 with an in- and out-of-network max of $10,000.

The expansive network is a stand-out feature with access to more doctors and health care facilities than any other plan we rated.

Why UnitedHealthcare is best for the largest network of doctors and specialists

No other MA plan we rated offers as many in-network doctors and specialists as UnitedHealthcare. But as HMO plans work, you’ll pay more if you decide to go out of network, and the annual out-of-pocket maximums may exceed your budget. If access is a priority, UnitedHealthcare is a great option.

Pros and cons of UnitedHealthcare Medicare plans

What we like about UnitedHealthcare MA Plans: The drawbacks of UnitedHealthcare MA Plans:
  • Coverage available in every state except Alaska
  • Largest MA network of doctors and specialists in the country
  • Many plans offer the Renew Active fitness benefit
  • Tend to be more expensive than other MA providers’ plans
  • SNPs are not available in every state

What do UnitedHealthcare Medicare Advantage Plans cover?

Most UnitedHealthcare Medicare Advantage Plans include:

  • Prescription drug coverage
  • Vision
  • Dental
  • Hearing
  • Wellness benefits, such as free gym memberships
  • Medical transportation (some plans)
  • Wellness over-the-counter medications (some plans)

Who should consider UnitedHealthcare Medicare Advantage Plans?

  • Accessibility is the hallmark of UnitedHealthcare in terms of service coverage, so it suits those who might have limited plan options based on geography.
  • With the most robust provider network in the country, accessibility is again the benefit — with more doctors and health care facilities in-network than any other insurer we reviewed.
  • If you’re willing to pay more for out-of-pocket expenses, you can get MA plans with $0 annual deductibles.

What Is a Medicare Advantage Plan?

Plan structure An alternative way to get your Medicare benefits, offered by private insurance companies who contract with a network of providers to keep costs low. An all-in-one plan that bundles together your hospital insurance and medical services and prescription drugs, plus extras that Medicare doesn’t cover.
Benefits available All Original Medicare Part A and B benefits, prescription drugs, and coverage for extras, such as vision, hearing, dental, and fitness club memberships.
Cost sharing Plans may have a monthly premium and deductible in addition to your monthly Part B premium. Copays and coinsurance apply for each service received until you reach your out-of-pocket max. Your costs are lowest if you stay in network.

How Medicare Advantage Plans Work

MA Plans, also known as MA or Part C, take the place of Original Medicare and provide coverage for the same benefits as Medicare Part A and Part B. There are many MA plans, most of which  provide Medicare prescription drug coverage to take the place of Medicare Part D.

MA Plans are regulated by the federal government but are administered by Medicare-approved private companies who set their own rules on how you receive your benefits. Cost structure and sharing are different, and all MA Plans include an out-of-pocket max to limit how much you pay for Medicare-covered (Parts A and B) services.

There are a few types of MA (Part C) Plans:

  • Health maintenance organization (HMO plans): Services provided by a network of providers. Primary care physician (PCP) and referrals to specialists required. May include prescription drug coverage. If not, you cannot purchase a stand-alone drug plan.
  • Preferred provider organization (PPO plans): Lowest cost services provided by a network of health care providers, but you can choose to receive care out of network. PCP and referrals are not required. May include prescription drug coverage. If not, you cannot purchase a stand-alone drug plan.
  • Private Fee-for-Service (PFFS): You choose Medicare-approved providers, and your health plan pays as long as the providers agree to treat you. May include drug coverage (Part D). If not, you can purchase a stand-alone drug plan.
  • Medical savings account (MSA): Combines with a high-deductible MA Plan. Your MSA pays for Medicare-covered services, then you pay out of pocket until you reach your deductible. Does not include drug coverage, so you can purchase a stand-alone plan.
  • Special needs plan (SNP): Tailored to fit the needs of certain special needs populations, such as those with chronic conditions, those who require long-term care in a facility, and those who are dually eligible for a Medicare health plan and Medicaid due to limited resources. SNPs offer specialized care, lowest costs, care coordination, and prescription drug coverage included.

Benefits available with a Medicare Advantage Plan

MA (Part C) Plans are required to provide the same benefits as an Original Medicare health plan does. These include:

  • Part A: Inpatient hospitalization and skilled nursing facility care and some home care. Hospice care, a Medicare Part A benefit, is still primarily provided by Original Medicare, not MA Plans.
  • Part B: Medically necessary outpatient care, supplies, and services, such as doctor’s visits, lab tests, and durable medical equipment

You can also join MA Plans for extra benefits. These typically include:

  • Part D – Prescription drug coverage per your health plan’s formulary
  • Routine vision exams
  • Routine hearing exams
  • Routine dental exams
  • Fitness benefits
Advantages of a MA Plan Disadvantages of a MA Plan
  • Services bundled in one plan
  • Costs savings if you stay in network
  • Most people have access to at least one zero premium plan with prescription drug coverage
  • Not all plans available in all areas
  • Network restrictions limit choice of providers
  • May not be able to buy a Medigap policy if you return to Original Medicare

Compare your Medicare plan options

See how MA Plan types compare with each other and with Original Medicare.

Plan type Costs* Part A coverage Part B coverage Part D coverage Out-of-state care**
Original Medicare Part B premium Yes Yes No Yes
MA  HMO Part B premium plus plan premium Yes Yes Usually Emergency only
MA  PPO Part B premium plus plan premium Yes Yes Usually Emergency, plus other care if in your plan’s network, or you pay more for out of network
MA  PFFS Part B premium plus plan premium Yes Yes Sometimes Emergency, plus other care if contracted with your plan and agrees to treat you.
MA  MSA Part B premium plus high deductible Yes Yes No Emergency plus other care but you pay higher cost for out of network if your health plan has a network
MA  SNP Part B premium Yes Yes Yes Emergency and out-of-area dialysis plus other care if in your plan’s network

*All plans include deductibles, copays, and/or coinsurance for services received. MA (Part C) Plans have an out-of-pocket max that applies to Medicare-covered benefits. There is no cap on what you spend for Original Medicare plan services, but if you purchase a Medigap plan, which has a monthly premium, it will cover most of Original Medicare’s cost-sharing requirements.

**Check with your plan for out-of-state coverage and service area.

How Do You Choose the Right Medicare Advantage Plan?

For the most comprehensive comparison of Medicare Advantage Plan benefits, use the Medicare Plan Finder on Medicare.gov.

ron square headshot

Expert advice: Factors for choosing the best Medicare Advantage Plan

  • Star ratings: The 40 measurements combined into the overall star ratings include customer satisfaction, the number of complaints, the appeals process, access to preventive care, if common prescriptions are affordable, and more.
  • Premiums and maximum out-of-pocket (MOOP): Premiums are typically low, or $0 in many areas. Max out-of-pocket costs set a limit on your costs for Part A and Part B services for the year, they are typically between $3,000 and $7,550.
  • Medications: The plan comparison tool allows you to enter your regular prescriptions to help determine plan coverage and cost. Watch for the drug deductible, copayments per tier, and check the formulary for inclusion and restrictions.
  • Your health care providers: If you’ve got favored caregivers and medical facilities, you’ll probably want a plan that includes all of them. HMO plans will typically require you to use in-network providers while PPO plans allow you to go out of network, usually at a higher cost.
  • Extra benefits: While all Advantage Plans must include A and B services, they also include extra benefits like dental, vision, hearing aids, gym memberships, over-the-counter goods, and more.

Who Is Eligible for a Medicare Advantage Plan?

Generally, if you are eligible for Medicare, you are eligible for a MA Plan. You must be enrolled in both Medicare Parts A and B and can only choose from plans that are available in your area. You cannot have a Medigap policy and a MA Plan at the same time.

You cannot be enrolled in hospice. If you need hospice care, you will return to Original Medicare under the Hospice Benefit.

Additional specific eligibility requirements for each type of MA Plan are:

  • HMO Plans: You must live or work in the plan’s service area.
  • PPO Plans: You must choose from a plan that is available in your area but may have access to a regional plan and can receive services that are out of network for a higher cost.
  • PFFS: You must choose from a plan that is available in your area but can see health care providers anywhere in the United States as long as they agree to treat you.
  • MSA: You cannot join an MSA if you:
    • Are eligible for Medicaid
    • Have health coverage that would cover your intended MA  MSA plan’s deductible. This includes benefits from a union or employer retirement plan
    • Are a retired employee of the federal government receiving benefits from the Federal Employee Health Benefits (FEHB) Program
    • Live outside of the United States more than 183 days per year
    • Receive TRICARE or U.S. Department of Veterans’ Affairs benefits
  • SNP: You must meet eligibility requirements within one of these categories:
    • Chronic Condition SNP (C-SNP): You must have at least one severe debilitating condition, such as chronic heart disease, autoimmune disorder, end-stage liver or kidney disease.
    • Institutional SNP (I-SNP): You live in an institution like a nursing home or require nursing care at home.
    • Dual-eligible (D-SNP): You have Medicare and Medicaid.

How Much Does a Medicare Advantage Plan Cost?

See how costs compare for these 2022 HMO and PPO plans in Chicago:

Plan name Monthly premium Deductible Copay Coinsurance Out-of-pocket max
Aetna Medicare Value PPO $0 $0 medical, $0 drug deductible PCP: $0

Specialist:$35

50% out of network $3,950 in network $8,250 in and out of network combined
Humana Choice H5216-251 PPO $0 $0 medical, $200 drug deductible PCP: $0

Specialist: $45

40% out of network $5,500 in network $10,000 in and out of network combined
Cigna Preferred Medicare HMO $0 $0 medical, $0 drug deductible PCP: $0

Specialist: $25

% out of network $3,150 in network

How Do I Enroll in a Medicare Advantage Plan?

To join a MA Plan, you first need to be enrolled in Original Medicare Part A (hospital insurance) and Part B (medical services). After you’re enrolled in an Original Medicare plan, you can enroll in a MA Plan during your Initial Enrollment Period or other times throughout the year:

  • Initial Enrollment Period (IEP): This seven-month period starts three months before the month of your 65th birthday, the month of your birthday, and ends three months after your birthday month.
  • Initial Coverage Enrollment Period (ICEP): This is when those who want to enroll in a MA Plan, and often occurs at the same time as the IEP for Original Medicare.
  • Annual Enrollment Period: This period runs from Oct. 15 through Dec. 7.
  • MA Open Enrollment: Medicare beneficiaries who already enrolled in a MA Plan can switch plans between Jan. 1 and March 31.
  • Special Enrollment Period (SEP): You may qualify for a SEP if your circumstances change, such as if you move or lose your current Medicare coverage.

There is one notable exception for SNPs. If you qualify for an SNP, you can enroll at any time.

Use the Medicare Plan finder to research available MA Plans in your area. When you’ve chosen a plan, go to the insurer’s website to check for online enrollment options or contact the insurance company by phone or email to request a paper enrollment form. You can also enroll by calling Medicare at (800) 633-4227.

To enroll, you need your Medicare number and the date your Medicare Parts A and B coverage began. Your Medicare card has this information.

Who Should Get a Medicare Advantage Plan?

Consider a MA Plan if you want your health care and Medicare prescription drug benefits bundled in one plan, and if you don’t mind choosing to receive your benefits from a network of providers.

You may also prefer cost-effective extra benefits that come with most MA Plans but understand those costs don’t apply toward your out-of-pocket max. MA Plans typically have lower monthly premiums than Medigap plans do, so if you don’t need much health care, you can save on upfront costs. Understand the risk of not being able to purchase a Medigap plan if you decide to return to Original Medicare more than a year after having a MA Plan.

Learn More From Our Sources

Kelly-Blackwell Headshot
Certified Senior Advisor (CSA)Ⓡ

As a health care professional since 1987, Kelly Blackwell has walked alongside and cared for seniors as they journey through the season of their fourth quarter of life. Blackwell holds a Bachelor of Science in nursing from the University of Northern Colorado, a Master of Science in health care administration from Grand Canyon University, an interprofessional graduate certificate in palliative care from the University of Colorado Anschutz Medical Campus and holds a Certified Senior Advisor® credential from the Society of Certified Senior Advisors.

Blackwell contributes to the University of Colorado-Anschutz blog and has been published in “The Human Touch” distributed by the University of Colorado Center for Bioethics and Humanities. She cowrote “Dying Is” for Pathways Hospice.

A registered nurse, Blackwell understands health insurance choices influence quality of life and are driven by values, goals, and beliefs. She’s passionate about engaging with, educating, and empowering seniors as they navigate the health care system. She’s equipped to lend an experienced, compassionate voice to beneficiaries seeking information about Medicare Advantage Plans.

As a CSAⓇ, Blackwell has access to valuable resources for Medicare beneficiaries. Her work as a bedside nurse and clinical manager has given her the opportunity to see how Medicare rules, regulations, and benefits work when patients need them. With a passion to learn and to make a difference in the lives of seniors, Blackwell supports seniors through Medicare and fourth-quarter life decisions.