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Medicare Advantage Plans (Part C)

A Medicare Advantage plan is an alternative to Original Medicare Parts A and B. These plans are offered by private companies approved by Medicare. The plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.   In addition, it may provide Part D prescription drug coverage, dental, vision and other wellness features.

Medicare Advantage plans in the Delaware Valley generally fall into four main types:

Medicare Advantage HMO

(Health Maintenance Organization)

You usually will save the most money on your health costs by joining a Medicare Advantage HMO. But, your choice of health care providers is limited to physicians and hospitals that participate with the HMO network and within the plan’s service area. When you choose a Medicare Advantage HMO, you'll need to choose a primary care physician who will oversee your care and refer you to specialists when necessary.  These plans almost always have copays and also may have deductibles and coinsurance.

Medicare Advantage PPO

(Preferred Provider Organization)

A Medicare Advantage PPO allows you to use physicians and hospitals within the plan’s network.  Unlike a Medicare Advantage HMO plan, you can choose doctors and services outside the PPO network for a fee, and you do not need referrals to see a specialist in or out of network.  However, these plans also may have copays and may have deductibles and coinsurance both in and out of network.

Medicare Advantage PFFS Plans

(Private Fee For Service)

These Advantage plans allow you to see any Medicare-approved doctor or hospital who accepts the plan's payment terms and agrees to treat you. Not all providers will. If you join a PFFS plan that has a network, you can also see any of the network providers who have agreed to always treat plan members.  These plans usually have copays and may have deductibles and coinsurance both in and out of network.  Unlike Advantage HMO’s and PPO’s you may purchase a prescription card separately from the PFFS plan.

Medicare Special Needs Plans

Medicare Special Needs Plans (SNPs) are more focused and specialized health care plans for specific groups of people, such as those who have certain chronic medical conditions like diabetes, or who have both Medicare and Medicaid (Dual Eligibles) or those who reside in a nursing home.

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