Medicare Advantage Plans (MAPD) Program & Coverages

Medicare Advantage Plans (Part C) are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Your Medicare services aren’t paid for by Original Medicare. The most common types of Medicare Advantage Plans are HMO, PPO, PFFS, and SNP.

In HMO Plans, you generally must get your care and services from providers in the plan’s network, except: emergency care, out-of-area urgent care, and out-of-area dialysis.

In PPO Plans, you have coverage for both in and out of network doctors, hospitals and other health care providers. You pay less if you use doctors, hospitals, and other health care providers that are in the plan’s network.

In PFFS Plans, the plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.