Medicare Advantage by State

Did you know the Medicare Advantage (Medicare Part C) program is available in almost every state, and lets you get your Original Medicare benefits through a private, Medicare-approved insurance company instead of directly from the government.

What is a Medicare Advantage plan?

If you currently are enrolled in Original Medicare, Part A and Part B, you can choose to enroll in Medicare Part C, more commonly known as Medicare Advantage. Medicare Advantage plans are offered by private health insurance companies to provide and coordinate Medicare Part A and Part B benefits (hospital and medical) for beneficiaries.

It’s important to understand the differences between the types of Medicare Advantage plans to see which works best for you. There are several different types of Medicare Advantage plans:

1. HMO (Health Maintenance Organization plan): Lets you see doctors and other health professionals who participate in its provider network. It could be a good option because you tend to pay less out-of-pocket with in-network doctors.


2. PPO (Preferred Provider Organization plan): May Cover both in- and out-of-network providers, giving you the freedom to choose any doctor that accepts Medicare assignment, which can work if you prefer that kind of flexibility.


3. PFFS (Private Fee-for-Service plan): The plan determines how much it will pay providers and how much you must pay when you get care. The treating doctor has to accept the plan’s payment terms and agree to treat you. If the doctor doesn’t agree to those terms, then the PFFS plan will not cover services through that doctor.


4. SNP (Special Needs Plans): Are especially for people who have certain special needs. The three different SNP plans cover Medicare beneficiaries living in institutions, those who are dual-eligible for Medicaid and Medicare, and those with chronic conditions such as diabetes, End Stage Renal Disease (ESRD), or HIV/AIDS. This type of plan always includes prescription drug coverage.


5. HMO-POS (Health Maintenance Organization – Point of Service plan): Covers both in- and out-of-network health services, but at different rates. You may pay less out-of-pocket when you go to in-network doctors, labs, hospitals, and other health care providers.


6. MSA (Medical Savings Account plan): Includes both a high deductible and a bank account to help you pay that deductible. The amount deposited into the account varies from plan to plan. The money is tax-free as long as you use it on IRS-qualified medical expenses, which include the health plan’s deductible.