Medicare Advantage Plans

Medicare Advantage Plans are private health care programs. Medicare Advantage Plans require Medicare Part and Part B. Part B premium payments are made to Medicare along with any extra benefits private insurance provides.

Medicare Advantage Healthcare Options

This includes Health Maintenance Organizations (HMO) which may or may not include prescription drug coverage. If you choose the HMO insurance, you have to make sure doctors and hospitals are part the plan's network. HMO's have specific formularies for prescription drugs and certain medications may not be covered. Each plan should be checked to make sure each medication is covered.

Preferred Provider Organization (PPO) plans also fall under Medicare Advantage Plans. PPO's do not require a Primary Care Physician or a referral to see a specialist outside the network. There may be deductibles with PPO plans although out-of-pocket costs are limited and network costs are low.

Private Fee-for-Service and Medicare Special Needs Plans are two other options. Private Fee-for-Service is paid with a set amount of money monthly to the private insurance company. With this plan, the private insurance or doctor determines how much is paid for the services received.

Medicare Special Needs Plans covers Medicare Part A, Part B and Part D which is for prescription drug coverage. Drug formularies are created to match specific groups of people with certain medical diseases or conditions. Medicare can help manage different services and providers. They can make it easier to follow doctor's orders related to diet and prescription drug use.

You can choose a Medicare Advantage Plan without prescription drug coverage (Part D) if your private health plan covers prescription drugs. The benefits of the Medicare Advantage Plan include having one insurance card, lower co-payments and better prescription drug coverage.

Although you are legally entitled to keep Medigap, any cost-sharing, deductibles and copayments will not be covered if you choose a Medicare Advantage Plan.

*You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week;


  • The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call, 1-800-325-0778; or Your State Medicaid Office.