Medicare Advantage vs. Original Medicare

Medicare Advantage plans from Peoples Health: get more than Original Medicare

Peoples Health Medicare Advantage plans offer all benefits covered by Original Medicare. Medicare Advantage plans are another way for people eligible for Medicare to receive coverage for medical services.

Medicare Advantage plans are regulated by the Centers for Medicare & Medicaid Services. While Medicare covers services received from any health care facility or any doctor who accepts Medicare, people who join a Medicare Advantage plan have a specific network of providers and hospitals from which they can receive services.

Members of a Medicare Advantage plan still pay their Medicare Part B premium, and they may pay a premium for the Medicare Advantage plan. Not all Medicare Advantage plans have a premium.

Medicare Advantage plans vs. Original Medicare

Medicare Advantage plans usually offer coverage for more services, such as health club memberships, programs to help manage certain health conditions, and other “extra” benefits, such as routine vision care or preventive dental care.

Who is eligible to join a Medicare Advantage plan?

To enroll in a Medicare Advantage plan, you must:

Be entitled to Medicare Part A and enrolled in Medicare Part B
Live in the plan’s service area

Confused about parts A and B? Learn more about the ABCs of Medicare.

How do Medicare and Medicare Advantage plans work together?

Medicare Advantage plans work with Medicare to provide coverage for health care benefits to people with Medicare. The plans must follow rules and standards set by Medicare. The federal government pays Medicare Advantage plans to provide all Medicare-covered benefits. If there is a difference between the amount a Medicare Advantage plan is paid by Medicare and the plan’s actual cost to provide benefits, the plan must use any savings to provide additional benefits or reduce costs for members of the plan. This is how some Medicare Advantage plans provide coverage for services such as routine vision care and routine dental care, which are not covered by Medicare.

Medicare issues quality ratings for Medicare Advantage plans. Medicare surveys people who join a Medicare Advantage plan to measure the overall quality of the plans, including quality of care, plan members’ ability to access care, plan responsiveness and member satisfaction. Individual Medicare Advantage plans are rated on a scale of 1 to 5 stars, with 5 stars being the highest score.

To view star ratings, go to Medicare’s website or our Medicare Star Ratings Page.

*Every year, Medicare evaluates plans based on a 5-star rating system.

What is a Medicare Advantage prescription drug plan?

A Medicare Advantage prescription drug plan is a Medicare Advantage plan that offers Medicare Part D prescription drug coverage, as well as medical coverage.

What are the types of Medicare Advantage plans and Medicare Advantage prescription drug plans?

There are many different types of Medicare Advantage and Medicare Advantage prescription drug plans:

Health Maintenance Organization

A health maintenance organization (HMO) plan covers care received from a specific network of doctors, hospitals and health care facilities. Members of an HMO plan generally must use these specified health care providers, and each member has a primary care provider.

Point-of-Service Plan

Some HMO plans have a point-of-service (POS) option, which lets people who join the plan see providers who are not in the plan’s network for certain covered services. Out-of-network services will usually have a higher cost to the member. Some services may require prior approval.

Chronic Condition Special Needs Plan

A chronic condition special needs plan (C-SNP) is designed for people with certain health conditions, such as diabetes, cardiovascular disease or chronic heart failure. These plans include benefits and services tailored to support these conditions.

Preferred Provider Organization

A preferred provider organization (PPO) plan is similar to an HMO plan because it has a network of doctors, hospitals and health care facilities for plan members to use. Members of PPO plans also have the option to see providers who are out of network, although the member may pay higher costs for out-of-network services. Out-of-network services do not require prior approval.

Dual-Eligible Special Needs Plan

A dual-eligible special needs plan (D-SNP) addresses the health care needs of individuals who are eligible for both Medicare and Medicaid.

Employer Group Waiver Plan

An employer group waiver plan (EGWP) is an employee (or retiree) benefit plan established or maintained by an employer, an employee organization (such as a union) or a church group that provides medical care to employees and their dependents directly.

Private-Fee-for-Service

A private-fee-for-service (PFFS) plan is administered by an independent insurance agency. A PFFS plan differs from the other plans listed above because it allows plan members to go to any health care provider or hospital anywhere in the United States that agrees to accept the terms of the PFFS payment agreement.

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