What Is Medicare Advantage?

Medicare Advantage (Part C) is an alternative to Original Medicare. Private insurance companies approved by Medicare offer these plans, and they must cover everything Original Medicare covers — plus they often bundle in extra benefits like dental, vision, and hearing coverage.

Most Medicare Advantage plans also include Medicare Part D prescription drug coverage, eliminating the need for a standalone drug plan. The two most common plan structures are HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization).

Quick Reference: Key Differences

Which Plan Type Is Right for You?

There's no one-size-fits-all answer. The best plan depends on your health needs, lifestyle, and financial priorities. Here are real-world scenarios to guide your thinking.

Don't Forget Prescription Drug Coverage

Most Medicare Advantage plans — both HMO and PPO — bundle in Medicare Part D drug coverage. This means you typically don't need a separate Part D plan. However, it's critical to verify that your specific medications are covered on the plan's formulary (drug list) before enrolling.

If you have significant drug costs, comparing formularies between HMO and PPO options in your area can reveal meaningful savings. Tier placement, prior authorization rules, and quantity limits vary by plan — not just by plan type.

What About Medicare Supplement Plans?

It's worth noting that Medicare Supplement (Medigap) plans are a completely separate product. These plans work alongside Original Medicare — not with Medicare Advantage — and help cover gaps like deductibles, copayments, and coinsurance.

If you value total freedom to see any Medicare-accepting provider nationwide without network restrictions, a Medicare Supplement plan paired with Original Medicare and a standalone Medicare Part D plan may be worth comparing against Medicare Advantage options.

• HMO Medicare Advantage: Low cost, network-based, includes drug coverage
• PPO Medicare Advantage: Flexible, higher cost, includes drug coverage
• Medicare Supplement + Original Medicare: Maximum freedom, no network, requires separate Part D

Questions to Ask Before You Enroll

Before choosing between an HMO and PPO Medicare Advantage plan, get answers to these key questions:

• Are my current doctors and preferred hospitals in the plan's network?
• Do I need referrals to see my existing specialists?
• Are all my prescriptions covered on the plan's formulary, and at what tier?
• What is the plan's annual out-of-pocket maximum?
• Does the plan offer coverage when I travel outside my home service area?
• What extra benefits are included — dental, vision, hearing, fitness?
• What are the total estimated costs for my specific health situation?