Life is full of choices. Most of the time, you have a pretty good idea of what each option entails, which helps you make the best choice for you. Sometimes, though, you need to do a little research. And that's why you're here today. You want to learn more about Medicare Advantage plans and the benefits of the different plan types.

Although every Advantage plan has the same core benefits – everything you get with Original Medicare – most of them also offer additional coverage, like prescriptions or routine dental care. But even more, the types of plans are also different. Some have provider networks; others may require extra layers of approval before receiving certain services. On this page, we look at the main types of Medicare Advantage plans and explain the pros and cons of each, to help you make an informed decision about your Medicare coverage.

What's the difference between Original Medicare and Medicare Advantage?

Original Medicare includes two parts:

• Medicare Part A covers inpatient care received in a hospital or skilled nursing facility, as well as hospice and some home healthcare services.
• Medicare Part B helps pay for outpatient services like doctor visits, mental health care, lab work, and durable medical equipment.

It does not cover prescription drugs. For that, you need a Medicare Part D plan. Original Medicare also doesn't pay for routine vision or dental care, nor does it cover hearing aids. To receive coverage for those services, you'd need ancillary insurance.

Or, you can choose a Medicare Advantage health plan that provides comprehensive coverage. Also known as Medicare Part C, every Advantage plan must provide the same benefits you get with Original Medicare (except hospice care, which is still provided by Part A). But, they can also give you extra benefits, and 90% of them do. The most common extras are:

• Prescription drug coverage (known as a Medicare Advantage Prescription Drug plan, or MA-PD)
• Routine vision services, including prescription eyeglasses
• Routine dental care
• Hearing aids
• Fitness benefits like SilverSneakers

Medicare Advantage plans are provided by private insurance companies who contract with the Centers for Medicare & Medicaid Services (CMS), working within federal guidelines. Prices and coverage vary, so it's important to review your plan options carefully. That can be a challenge if your zip code has a variety of Advantage plans available. This is where a good Medicare agent can help. They'll explain your options and help you find a plan that meets your individual needs.

Understanding the different types of Medicare Advantage plans

The four most common types of Medicare Advantage plans are:

• Health maintenance organizations (HMOs) typically limit services to a network of providers that may include doctors, nurses, labs, pharmacies, hospitals, durable medical equipment suppliers, and more. Care received from an out-of-network provider may not be covered outside of cases of medical emergency. In addition, plans typically require members to choose a primary care provider (PCP) to manage care and write referrals for specialists.
• Preferred provider organizations (PPOs) also have a provider network. However, you can usually go to a non-preferred provider if you're willing to pay a higher co-pay. PPO plans also don't require you to pick a primary care physician or get a referral before visiting a specialist.
• Private fee-for-service (PFFS) plans set prices for covered services. They also contract with a network of healthcare providers who agree to provide care, even for new patients. However, the provider may accept some of the PFFS plan's prices and reject others. You should always check whether the provider will accept your plan's price before receiving treatment.
• Special needs plans (SNPs) are designed specifically for people who are part of a certain "community." This could mean having a specific condition, such as diabetes or heart failure; living in an institution or requiring home nursing care; or being dual eligible (having both Medicare and Medicaid). Everything about this health insurance plan is geared toward people in that community, including specialists and covered prescription medications.

You'll notice that list doesn't include exclusive provider organizations (EPOs). That's because there aren't a lot of EPO Medicare Advantage plans. The plans are similar to both PPOs and HMOs. As with an HMO plan, you have to go to an in-network provider if you want coverage and it's not an emergency. And like PPO plans, you don't need a referral to see a specialist. Monthly premiums and other out-of-pocket costs tend to fall between HMO and PPO levels (HMO premiums are usually the lowest of the four main types).

How do provider networks work?

Health insurance providers employ provider networks as part of their effort to lower costs. The doctors, nurses, clinics, and other healthcare providers in the network agree to accept the plan's terms regarding price, which services are covered, and more.

When you receive care from an in-network provider (also known as a preferred provider), you nearly always pay less than if you go out-of-network.

Most Medicare Advantage plans have a provider network. Check the details with your plan provider to understand whether out-of-network care is covered.

Is an HMO or EPO better for me?

When it comes to comparing HMO and EPO plans, neither is inherently better. It depends on your needs and what you prioritize. To decide which type of plan is better for you, you can start by listing all of the doctors, hospitals, and other providers that are important for you to have access to. When comparing plan, compare your list to the plan's network.

Now the question becomes: How important is it to see whatever doctor you want? If the answer is, "Very," then you probably want a PPO Medicare Advantage plan. Provider networks change every year. If you don't want to lose your doctor, that may not be a risk you're willing to take.

The next question is around referrals. If you have chronic conditions that require specialist care, the referral hurdle may become annoying. In that case, either a PPO or EPO may be better.

Finally, we look at cost. HMOs tend to cost the least. But make sure you look carefully at all of the out-of-pocket costs, not just the monthly premium. Yearly deductibles, co-pays, co-insurance, and the yearly max-out-of-pocket also contribute to your total out-of-pocket.

Are you ready to join a Medicare Advantage plan? Just call us toll-free at 1-888-992-0738 to talk to one of our licensed Medicare agents. They'll explain your plan options and answer your questions in language you can understand. Or, you can compare plans in your area to find the plan that is right for you.