What Does Medicare Advantage Cover?

Because it is different from Original Medicare, Medicare Advantage varies between plans. The most common variations of these plans include:

Health Maintenance Organization (HMO)

• In-network care except for emergency visits, out-of-area urgent care, or out-of-area dialysis
• Most cover prescription drugs
• Most require a primary care doctor and specialist referral

Preferred Provider Organization (PPO)

• Allows for out-of-network visits
• Most cover prescription drugs
• No primary care doctor required
• Does not require specialist referrals

Private Fee-for-Service (PFFS)

• Allows out-of-network care by those who accept the plan’s terms
• Prescription drug coverage depends on the provider
• Does not require a primary care doctor
• Does not require specialist referrals

Special Needs Plans (SNPs)

• Plans tailored to their group’s needs
• Requires in-network care unless for emergencies or out-of-area dialysis
• Offers full prescription drug coverage
• Most require a primary care doctor
• Check for limited membership requirements

Medicare Part C features an incredible variety of coverage options. This way, you can pick the plan and provider that works best for you.