Key takeaways:
Medicare Advantage (MA) plans offer an alternative to original Medicare. They often include extra benefits, such as dental, vision, hearing, and prescription medication coverage.
There are six MA plan types. Each comes with its own rules, networks, and costs. Health maintenance organization (HMO) plans are the most common, followed by preferred provider organization (PPO) plans.
Most people can join or switch Medicare plans during the annual open enrollment period, which is October 15 to December 7. If you already have an MA plan, you can also make changes during the Medicare Advantage open enrollment period, which is January 1 to March 31.
Choosing a Medicare Advantage (MA) plan, also known as Medicare Part C, can feel overwhelming. There are six plan types, but you may not qualify to choose some of them. Each Medicare Advantage plan type comes with its own rules, costs, and networks. MA plan costs and benefits can change annually, so you may want to compare the offerings each year before it’s time to join or switch your coverage.
During the annual Medicare open enrollment period, from October 15 to December 7, you can compare plans and enroll in coverage for the next year. If you already have an MA plan, you get a second chance to make changes after the coverage year has started during the annual Medicare Advantage open enrollment period, which is January 1 to March 31.
Here’s what to know about the six types of Medicare Advantage plans, which can help you determine whether one might be a better fit for your healthcare needs and budget than the others.
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What is a Medicare Advantage plan?
For those who qualify for Medicare — including individuals age 65 and older and younger people with disabilities — Medicare Advantage plans offer an alternative way to receive Medicare benefits versus original Medicare. More than half of Medicare beneficiaries (about 34 million people) were enrolled in MA plans in 2025. These plans combine Medicare Part A (hospital and inpatient coverage) and Part B (outpatient and other medical coverage). Most MA plans provide prescription medication benefits as well.
MA plans often include some dental, vision, and hearing care benefits. Many — but not all — MA plans require no premium beyond what you pay for Part B. Some MA plans also cover part of your Part B premium. All MA plans have an out-of-pocket limit, which is an annual cap on your out-of-pocket spending.
List of Medicare Advantage plans
Understanding your coverage options means 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. It’s also important to note whether you qualify for a certain type of MA plan.
Here’s a breakdown of the different Medicare Advantage plans.
1. Health maintenance organization (HMO) plans
These plans limit coverage to their network healthcare professionals and facilities, 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.
More than half of MA enrollees are signed up for HMO plans. With an HMO plan, you usually have fewer in-network healthcare professionals and facilities, which limits your choices. But your out-of-pocket costs are often lower than other types of MA plans such as PPOs, which allow enrollees more flexibility in choosing care — often at a higher cost.
According to KFF, the average in-network out-of-pocket spending limit for HMO plans in 2025 was $4,091. The average limit across HMO and PPO plans combined was $5,320.
HMO pros and cons
Pros | Cons |
|---|---|
Lower out-of-pocket costs than many other plans | Must stay in the plan’s limited network for most care, except for emergencies |
Usually includes extra benefits, like dental, vision, and prescription medication coverage | Referrals are usually required to see specialists |
2. Preferred provider organization (PPO) plans
A PPO, the second-most common type of MA plan, covered about 44% of enrollees in 2025. With a PPO plan, you have more flexibility to see specialists without a referral from your primary care healthcare professional. You typically pay less when you receive care from healthcare professionals and facilities in the plan’s network, but you are allowed to choose. If you go out of network, your costs are typically higher.
PPO plans can be local, meaning they serve a specific county or state. Some are regional and cover a larger area, which may include multiple states. In 2025, the average out-of-pocket spending limit for local PPOs was $9,519, including in-network and out-of-network care. For regional PPOs, the combined limit was $11,001.
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Some PPO plans also include a yearly deductible for certain services. Prescription medication coverage is often included.
PPO pros and cons
Pros | Cons |
|---|---|
More flexibility to receive out-of-network care | Usually higher costs than HMOs, including premiums and cost sharing when you receive care |
No referrals needed to see specialists | May have higher out-of-pocket costs, especially for out-of-network care |
Often includes extra benefits (like dental, vision, hearing, and prescription drug coverage) | May have a yearly deductible for some services |
3. Private fee-for-service (PFFS) plans
PFFS plans are far less common than HMO and PPO plans. Some PFFS plans have a network of healthcare professionals and facilities. If yours does, you’ll generally pay less when receiving care when you stay in that network. Other PFFS plans don’t have a network. In that case, you may be able to receive care from any healthcare professional or facility, as long as they accept Medicare reimbursement and agree to your plan’s payment rules.
But not all healthcare professionals who accept Medicare agree to a PFFS plan’s terms. Even if a healthcare professional or facility accepts your plan for one visit, this could change in the future. You may need to confirm coverage before each appointment.
Many PFFS plans don’t include prescription medication coverage, which means you may need to enroll in a separate Part D plan.
PFFS pros and cons
Pros | Cons |
|---|---|
Flexibility to see healthcare professionals who accept the plan’s payment terms | May have higher premiums and out-of-pocket costs than HMO or PPO plans |
No referrals needed to see specialists | Many plans do not include prescription medication coverage |
4. Special needs plans (SNPs)
These plans are designed for people who have specific health conditions or meet certain requirements. All SNPs must provide Medicare prescription medication coverage. In 2025, about 1 in 5 Medicare enrollees — 21% — had SNPs, according to KFF. SNPs can be HMOs or PPOs.
Unlike other MA plans, a healthcare professional — like a social worker or a case manager — usually refers someone for enrollment in an SNP if they appear to be eligible.
There are also 3 types of SNPs. You may qualify for the:
Chronic condition SNP: If you have a chronic or disabling condition, such as heart failure or diabetes
Dual-eligible SNP: If you are eligible for both Medicare and Medicaid
Institutional SNP: If you live in a care facility, such as a nursing home
All SNP plans include prescription medication coverage. These plans also offer more supportive benefits than other MA plans. Most people in SNPs have access to benefits like transportation, meals, and bathroom safety devices that aren’t generally available in other MA plans. Many SNPs also focus their benefits on condition management needs.
SNP pros and cons
Pros | Cons |
|---|---|
Includes prescription medication coverage | Available only to people who meet eligibility rules |
Care designed for your specific health needs | Not available in all areas |
Access to helpful benefits like transportation, meals, and home safety devices | May require referrals to see specialists |
5. Medical savings account (MSA) plans
These plans combine a high-deductible MA plan with a medical savings account, similar to a health savings account (HSA). Each year, Medicare gives the plan money for you, which is deposited into your medical savings account. In this consumer-managed account, you use these funds to pay for your healthcare costs until you meet your deductible. Once you meet the deductible, the plan starts covering your costs.
There are very few MSA plans offered. And these plans don’t include prescription medication coverage, so you would need a separate Part D plan.
You generally can’t enroll in an MSA plan if you:
Have other coverage that pays your deductible, such as employer or retiree coverage
Are enrolled in another MA plan
Receive benefits from Tricare, the U.S. Department of Veterans Affairs (VA), or the Federal Employee Health Benefits Program
Qualify for Medicaid
Are receiving hospice care
Live outside the U.S. for more than half the year (183 days total)
MSA pros and cons
Pros | Cons |
|---|---|
Flexibility to decide how to use the money in your medical savings account for healthcare | High deductible must be met before plan coverage begins |
No network restrictions for covered services | No prescription medication coverage included |
6. HMO point-of-service (HMO-POS) plans
With a typical HMO, you must stay in your network for covered care. But with an HMO-POS plan, you can receive out-of-network care, but you’ll generally pay more. Unlike PPO plans, you’ll likely still need referrals to see specialists in your plan’s network.
These plans usually have separate deductibles for in-network and out-of-network services. You usually pay the lowest out-of-pocket costs when you receive care from healthcare professionals and facilities in the plan’s network. Prescription medication coverage is generally included.
HMO-POS pros and cons
Pros | Cons |
|---|---|
More flexible care options than standard HMO plans | May need referrals to see specialists |
Lower costs when staying in network | May have higher premiums than standard HMO plans |
Compare Medicare Advantage plans
Each type of MA plan handles costs and coverage differently. The table below helps you compare the types of Medicare Advantage plans.
Type of MA Plan | Premium | Healthcare professionals | Referrals |
|---|---|---|---|
HMO | Many HMO plans charge a monthly premium in addition to your Part B premium. | You must receive services from healthcare professionals 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 healthcare professional to see specialists for the care to be covered by your plan. |
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 plan’s preferred healthcare professionals and facilities. | You don’t need referrals to see specialists. |
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. |
SNP | SNP plans may charge a monthly premium in addition to your Part B premium. | Some SNP plans require you to stay in 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. |
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-POS | HMO-POS plans generally charge a higher monthly premium than HMO plans. This is on top of the part B premium. | Receiving care 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 provider to see in-network specialists, but not for out-of-network specialists. |
What to consider in a Medicare Advantage plan
When considering an MA plan, 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 deductibles, premiums, copays, coinsurance, and out-of-pocket limits to calculate your potential costs.
Network: Check to see if your preferred healthcare professionals and facilities are in the plan’s network before enrolling. You can use the Medicare plan finder tool to compare. MA plans are required to provide network directories, but these lists may not always be accurate. For plans that allow out-of-network care, consider whether that flexibility is worth the higher costs.
Referral requirements: Find out if you need to obtain referrals from your primary care healthcare professional before seeing specialists.
Quality ratings: Check the Medicare star ratings of different MA plans in your area. These ratings reflect how plans perform in areas such as customer service, care coordination, and member satisfaction.
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 $283 in 2026. There’s no annual limit on your out-of-pocket costs unless you have Medigap supplemental coverage. | Out-of-pocket costs will vary depending on the services you receive. But there’s a cap on your yearly out-of-pocket costs. In 2026, this limit is $9,250 for in-network care and $13,900 if you have a plan that covers in-network and out-of-network services. |
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 facility choice | You can visit any healthcare professional who accepts Medicare in the U.S. or U.S. territories. | You generally must stay in the plan’s network for your care, though some plans offer out-of-network benefits. You may need a referral from your primary care healthcare professional to see a specialist, depending on the type of MA plan. |
Unlike original Medicare, MA plans often have geographic restrictions on where you can receive care. This typically means fewer options or higher costs when seeking care outside your local area.
If you spend time in different states or travel often, original Medicare may be a better fit because of its nationwide coverage.
Are Medicare Advantage plans bad if you’re interested in Medigap insurance?
It depends on your situation. Medigap is supplemental insurance for people with original Medicare that fills in coverage gaps by reimbursing out-of-pocket expenses like deductibles and copays.
By choosing an MA plan, you may forfeit your right to buy Medigap down the road, should you go back to original Medicare. This is because if you start with an MA plan and later want to switch to original Medicare with Medigap, insurance companies may deny coverage or charge a higher premium.
Take time to understand your guaranteed issue rights for Medigap — when insurers must sell you Medigap coverage without medical underwriting (conditions based on your health) — and whether you have a “trial right” to try an MA plan without losing Medigap eligibility later.
Overall, consider the benefits of original Medicare versus Medicare Advantage, but also compare your coverage with MA versus original Medicare with Medigap. When it comes to an MA plan, what’s right for a family member or a friend might not be right for you.
If you feel overwhelmed, free help is available through the State Health Insurance Assistance Program (SHIP), which connects you with trained benefits counselors who can explain your Medicare options including how original Medicare with Medigap can factor into your decision.
The bottom line
If you’re considering Medicare Advantage (MA), compare the types of plans you are eligible to join and their benefits. Health maintenance organization (HMO) plans are the most popular option and can save you money, but they come with restrictions on the healthcare professionals and facilities that you can use. You may want to look into preferred provider organization (PPO), private fee-for-service (PFFS), and other less common plans to see which option fits your needs. Plus, MA plan costs and coverage can change annually, so make sure to carefully consider your options each year before open enrollment.
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References
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Freed, M., et al. (2024). Medicare Advantage 2025 spotlight: A first look at plan offerings. KFF.
Medicare.gov. (n.d.). Compare original Medicare & Medicare Advantage. Centers for Medicare & Medicaid Services.
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Medicare.gov. (n.d.). Learn how Medigap works. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Medicare medical savings account (MSA) plans. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Special needs plans (SNP). Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Understanding health plan costs. Centers for Medicare & Medicaid Services.
Medicare.gov. (2025). Understanding Medicare Advantage plans. Centers for Medicare & Medicaid Services.
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Ochieng, N., et al. (2025). Medicare Advantage in 2025: Premiums, out-of-pocket limits, supplemental benefits, and prior authorization. KFF.
