What Are the 6 Different Types of Medicare Advantage Plans? Here’s a Complete List
Key takeaways:
Medicare Advantage (MA) plans offer an alternative to traditional Medicare coverage.
You have a choice of six MA plan types, and each comes with its own rules, networks, and costs.
Health maintenance organization (HMO) plans are the most popular type, followed by preferred provider organization (PPO) plans.
Table of contents
Medicare Advantage (MA), or Medicare Part C, offers six plan types. Choosing the right MA plan starts with understanding your coverage options. That includes knowing the differences between plan types and whether you prefer the open networks of preferred provider organization (PPO) plans, the cost-saving structure of health maintenance organization (HMO) plans, or a hybrid approach.
Learning about the six different types of Medicare Advantage plans will help you determine whether one might be a good fit for your healthcare needs and budget.
What is a Medicare Advantage plan?
For those who qualify for Medicare — including individuals age 65 and up and younger people with disabilities — Medicare Advantage plans, or Medicare Part C plans, offer an alternative way to get covered. These plans combine Medicare Part A (inpatient coverage) and Part B (outpatient coverage). Most MA plans provide prescription medication coverage as well.
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Most MA plans also include dental, vision, and hearing care benefits. Many MA plans require no premium beyond what you pay for Part B. Some MA plans might also cover part of your Part B premium. And the federal government requires MA plans to cap how much you spend out of pocket for your care every year.
List of Medicare Advantage plans?
Medicare Advantage plan type | Description |
|---|---|
Health maintenance organization (HMO) | These plans limit you to getting care within their network, except for emergencies. If you see a healthcare professional outside the network, you’ll likely be responsible for the entire bill. Prescription medication coverage is usually included. |
Preferred provider organization (PPO) | With these plans, you pay less out of pocket if you choose in-network care instead of out-of-network care. They may impose an annual deductible. Prescription medication coverage is often included. |
Private fee-for-service (PFFS) | These less common plans may be network based. They may require out-of-network healthcare professionals and facilities to accept both Medicare reimbursement and the plan’s terms and conditions. Most don’t include prescription medication coverage. |
Special needs plan (SNP) | These plans are designed for people with chronic conditions, like diabetes, and those who qualify for both Medicare and Medicaid. All SNPs must provide Medicare prescription medication coverage. |
Medical savings account (MSA) | These plans are not widely available. They combine a high-deductible plan with a dedicated savings account — similar to a health savings account. Funds for healthcare expenses are deposited into the account yearly. MSAs don’t include prescription medication coverage. |
HMO point-of-service (HMO-POS) | These hybrid HMOs let you go outside your network for treatment, provided you’re willing to pay more for that care. Typically, there are separate deductibles for in-network and out-of-network charges. Prescription medication coverage is generally included. |
Compare Medicare Advantage plans
Each type of MA plan handles costs and coverage differently. The table below helps you compare Medicare Advantage plans.
Type of MA Plan | Premium | Providers | Referrals |
|---|---|---|---|
Health maintenance organization (HMO) | Some HMO plans charge a monthly premium in addition to your Part B premium. | You must receive services from providers in the plan’s network. For care outside the network, you generally have to pay the entire bill. | You need a referral or a prior authorization from your primary care team to see specialists. |
Preferred provider organization (PPO) | Many PPO plans charge a monthly premium in addition to your Part B premium. | You can receive both in-network and out-of-network care, but you’ll pay less if you stick to the network. | You don’t need referrals to see specialists. |
Private fee-for-service (PFFS) | PFFS plans usually charge a monthly premium in addition to your Part B premium. | You can receive care from any healthcare professional who accepts Medicare and agrees to the plan’s payment terms. | No referrals are needed for specialists. |
Special needs plan (SNP) | SNP plans may charge a monthly premium in addition to your Part B premium. | Some SNP plans restrict you to their network for care. Others allow out-of-network care but at higher costs. | Referrals may be required for certain services, but it varies by plan. |
Medicare medical savings account (MSA) | There are no additional premiums with MSA plans, but you must continue to pay your Part B premium. | There are no network restrictions as long as the healthcare professional and facility accept Medicare. | You don’t need referrals to see specialists. |
HMO point-of-service (HMO-POS) | HMO-POS plans generally charge a higher monthly premium than HMO plans. This is on top of the part B premium. | Going outside your plan’s network is an option, but it will likely cost you more. | You need a referral or a prior authorization from your primary care team to see in-network specialists. But a referral or a prior authorization is not needed to receive out-of-network care. |
The most popular type of Medicare Advantage plan: health maintenance organization (HMO)
Nearly 33 million Americans were enrolled in MA plans in 2024, and more than half signed up for HMO plans.
With an HMO plan, you may have less choice in where you receive care. But your out-of-pocket costs are often lower than with other plans, like PPOs, that provide more options. According to KFF, the average out-of-pocket spending limit on in-network services in 2024 is $3,965 for HMO plans. That’s compared with an average out-of-pocket in-network spending limit of $4,882 for all MA plans. But you must stay in your plan’s networks, except for emergency care.
HMO pros:
Lower out-of-pocket costs compared with other plans
Usually includes extra benefits, like dental, vision, and prescription medication coverage
HMO cons:
Must stay in the plan’s network for most services (except emergencies)
Referrals are typically required to see specialists
Preferred provider organization (PPO) plans
About 45% of people enrolled in MA have a PPO plan. With these plans, you pay less when you stay in network for your care rather than going out of network. In 2024, PPO out-of-pocket spending limits are, on average, $8,634 in-network services and $10,728 for out-of-network care, according to KFF. You may also have to pay a yearly deductible for some of your care.
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If you have a healthcare professional you want to continue seeing, make sure they’re in your plan’s network before enrolling. “I advise people coming into Medicare to check with their own doctors and find out which MA plans, if any, they accept,” Patricia Barry, a journalist and the author of “Medicare for Dummies,” told GoodRx Health. Advantage plans are required to make in-network healthcare provider lists available to consumers. But some reports and many beneficiaries have found these lists to be inaccurate, out of date, or both, Barry said.
PPO pros:
More flexibility to receive care in and out of network
No referrals needed to see specialists
Usually includes extra benefits like dental, vision, and prescription medication coverage
PPO cons:
Higher monthly premiums than HMO plans
May have higher out-of-pocket costs, especially for out-of-network care
May have higher yearly spending limits than HMO plans
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Private fee-for-service (PFFS) plans
PFFS plans are far less common than HMO and PPO plans. If your PFFS plan has a network, you have access to providers in that network. If it doesn’t, you may be able to receive care from any healthcare professional or hospital that accepts Medicare and your plan’s terms and conditions.
The downside? Not all healthcare professionals who accept Medicare will go along with your plan’s terms and conditions. “Watch for a limitation on the number of providers who are willing to do so,” David Lipschutz, the associate director of the Center for Medicare Advocacy, told GoodRx Health.
Even if a healthcare professional or facility accepts your PFFS plan, they can choose not to accept it for future visits. This means you’ll need to check your coverage before each appointment, Barry added. Plus, most PFFS plans don’t include prescription medication coverage.
PFFS pros:
Flexibility to receive care from any facility that accepts the plan’s payment terms
No referrals needed to see specialists
PFFS cons:
May have higher premiums and out-of-pocket costs than HMO or PPO plans
May not include prescription medication coverage
Special needs plans (SNPs)
Nearly 7 million people are enrolled in SNPs in 2024, according to KFF. SNPs provide benefits and coordinated care for people who have specific health conditions or meet certain requirements.
“For most people, SNPs are not a choice but plans to which they are referred by medical or social workers,” Barry said.
SNP enrollees are typically people who:
Have eligibility for both Medicare and Medicaid
Have a chronic or disabling condition, such as heart failure or diabetes
Live in a care facility, such as a nursing home
SNP pros:
All SNP plans include prescription medication coverage
Extra benefits often tailored to the chronic conditions covered
SNP cons:
May need referrals for specialists
Not available in all areas
Medical savings account (MSA) plans
These plans pair a high-deductible health plan with a savings account. The insurer deposits money into this account, which is used to pay for healthcare costs. There are very few MSA plans offered nationwide. And these plans don’t include prescription medication coverage.
MSA pros:
Flexibility to use the savings account money as you choose for medical care
No network restrictions for covered services
MSA cons:
High deductible must be met before plan coverage begins
No prescription medication coverage included
HMO point-of-service plans (HMO-POS)
With a typical HMO, you must stay within your network to have medical care or services covered by your plan. An HMO-POS, like a PPO, lets you go outside your network, provided you’re willing to pay more for that care. Generally, there are separate deductibles for in-network and out-of-network charges.
HMO-POS pros:
More flexible than standard HMO plans
Lower costs when staying in-network
HMO-POS cons:
May need referrals to see specialists
May have higher premiums than standard HMO plans
What to consider in a Medicare Advantage plan
When considering an MA plan, it’s important to carefully review the details to ensure that the plan meets your healthcare needs and fits within your budget. Here are a few factors to consider:
Prescription medication coverage: Confirm that the plan includes Medicare Part D coverage for the medications you take.
Costs: Review the deductibles, premiums, copays, and coinsurance details to calculate your potential out-of-pocket costs.
Network: Check if your preferred healthcare professionals and facilities are in network. For plans that allow out-of-network care, weigh whether that flexibility is worth the higher costs.
Referral requirements: Find out if you need to obtain referrals from your primary care team before seeing specialists.
Quality ratings: Check the Medicare star ratings of different MA plans in your area to assess their quality.
Original Medicare vs. Medicare Advantage
Deciding between original Medicare and Medicare Advantage? Here are some key differences to consider.
Original Medicare | Medicare Advantage | |
|---|---|---|
Cost | You typically pay 20% of the costs of care after you meet your Part B deductible, which is $257 in 2025. There’s no annual limit on your out-of-pocket costs unless you have supplemental coverage. | Out-of-pocket costs will vary depending on the service you receive. But there’s a cap on your yearly out-of-pocket costs. In 2025, this limit is $9,350 for in-network care. |
Coverage | Most medically necessary services are covered. Eye exams and most dental and hearing care services are not covered. | MA covers everything original Medicare (Parts A and B) covers, plus extra benefits. Prescription medication coverage is often included. |
Foreign travel | Generally, original Medicare does not cover medical services outside the U.S. But Medigap (Medicare supplemental insurance) plans may cover care abroad. | Medical care outside the U.S. is generally not covered. Some plans offer emergency coverage during foreign travel. |
Healthcare professional and hospital choice | You can visit any provider who accepts Medicare in the U.S. or U.S. territories. | You generally must stay in the plan’s network for your care. You may need a referral from your primary care team to see a specialist. |
Unlike original Medicare, MA plans have geographic restrictions on where you can receive care. This typically means fewer options or higher costs when seeking care outside your local area.
“Beneficiaries who travel a lot within the U.S. or spend part of the year in different states need traditional Medicare, as coverage is nationwide,” Barry said.
Are Medicare Advantage plans bad if you’re interested in Medigap insurance?
It depends on your situation and future plans. Medigap is supplemental insurance for people with original Medicare. It fills in coverage gaps by reimbursing expenses like deductibles and copays.
By choosing an MA plan, you may forfeit your right to purchase Medigap down the road, should you go back to original Medicare, Lipschutz said. This is because if you start with an MA plan and later want to switch to original Medicare with Medigap, insurance companies might deny you coverage or charge you much more.
Take time to understand your guaranteed issue rights for Medigap — when insurers must sell you Medigap coverage — and whether you have a “trial right” to try an MA plan without losing Medigap eligibility later.
Overall, you’ll want to weigh the benefits of original Medicare versus MA plans, but you’ll also want to compare MA plans with Medigap. When it comes to an MA plan, what’s right for someone you know might not be right for you.
“Often, people will go with plans that have been marketed to them, recommended by friends, family, insurance brokers, or others, even if such plans aren’t the best fit for them,” Lipschutz said.
If you feel overwhelmed, free help is available through the State Health Insurance Assistance Program, which connects you with trained benefits counselors who can explain your Medicare and Medigap options.
The bottom line
If you’re considering enrolling in a Medicare Advantage (MA) plan, you’ll want to compare individual plans and different types of coverage. Health maintenance organization (HMO) plans are the most popular option and can save you money, but they also come with restrictions. You may want to compare preferred provider organization (PPO), private fee-for-service (PFFS), and less common plans to see which option fits your needs. Plus, MA plan costs and coverage benefits can change annually, so make sure to carefully weigh your options each year before reenrolling.
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References
Centers for Medicare & Medicaid Services. (2012). Your guide to Medicare medical savings account (MSA) plans.
Centers for Medicare & Medicaid Services. (2024). 2025 Medicare Parts A and B premiums and deductibles.
Coleman, K.A. (2024). Final contract year (CY) 2025 standards for Part C benefits, bid review and evaluation. Centers for Medicare & Medicaid Services.
Freed, M., et al. (2024). Medicare Advantage in 2024: Enrollment update and key trends. KFF.
Freed, M., et al. (2024). Medicare Advantage in 2024: Premiums, out-of-pocket limits, supplemental benefits, and prior authorization. KFF.
Medicare.gov. (n.d.). Compare original Medicare and Medicare Advantage. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Compare types of Medicare Advantage plans. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Get ready to buy. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Learn how Medigap works. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Understanding health plan costs. Centers for Medicare & Medicaid Services.
