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Medicare Advantage Plans

Enter your Drug List and or your Provider List

Click on link above, and register or login to your HTA Medicareful Portal and securely enter your medication list.  If you are interested in looking into a Medicare Advantage Plan, you can also enter your list of existing health providers so we may check the network availability.

Medicare Advantage Plans…

Medicare Advantage Plans (otherwise known as Medicare Part C Insurance) work as your primary insurance to replace Medicare A and B (however, you are still responsible for paying your Medicare Part B premiums).

Medicare Advantage Plans are an “all in one” plan that can include Prescription Drug Benefits and even some ancillary benefits like dental, vision, hearing, and gym memberships.

All Medicare Advantage (MA) plans must cover all Part A and Part B benefits.  Most MA plans also cover part of the Original Medicare cost sharing benefits.

Certain chronic health conditions and/or low income may qualify you for a Specials Needs MA Plan.

Network Based Coverage

Medicare Advantage Plans have their own doctor networks.  There are various types of network arrangements to choose from: HMO, PPO, PFFS, MSA.

Networks may be regionally based.  It is important to know if you travel regularly or have multiple residences when choosing a proper plan.


HMO enrollees must generally use doctors and hospitals within the plan’s network to receive covered services.  Unless you are receiving emergency services and you are outside of your plans servicing area, there is likely no coverage if your provider does not participate with the plan.  You will have to pick a Primary Care doctor, and you may need referrals for specialists (many plans do not require referrals for most specialists).

  • If you want drug coverage, you must take the drug coverage offered with the plan.  You cannot purchase a standalone drug plan.

PPO Plans offer both in and out of network benefits.  With a PPO plan, you can see any doctor who accepts Original Medicare; however, you will pay more if the provider is not your specific plan’s network.  Typically there are lower copays if you stay within the network, and a higher percentage of cost (coinsurance) if you go out of network.  You are not required to pick a Primary Care Provider and do not need referrals for in network services.

  • If you want drug coverage, you must take the drug coverage offered with the plan.  You cannot purchase a standalone drug plan.
PFFS-Private Fee For Service

May receive covered services from any provider in the US who is eligible to provide medicare services and agrees to accept the plan’s terms and conditions of payment.  Except for emergencies, enrollees must inform providers before they receive services that they are a PFFS plan member so the provide can decide if they want to accept their coverage.  Cost sharing may include balance billing up to 15% of the Medicare allowable rate.

  • If you want drug coverage, you can take the coverage if offered with the plan.  Otherwise, you can get a PFFS plan without drug coverage and purchase a standalone drug plan.

A Medicare MSA is a high deductible health plan which is combined with a savings account used to pay for healthcare expenses.  Medicare contributes some money toward to the beneficiary’s savings account.  MSA enrollees pay for health care expenses from the savings account and then out of pocket until the annual deductible is met, after which the plan pays 100% for covered services.  MSA plans may not have a network or may have a full or partial network of providers.

  • MSA plans do not offer drug coverage.  You must enroll in a standalone drug plan if you want drug coverage.

Out of Pocket Limits

Premiums for Medicare Advantage plans are typically lower than Medicare Supplement premiums, but they may have higher maximum out of pocket limits.  In 2021, the Maximum In Network out of pocket limit that can be on any plan is $7,550 (and $11,300 out of network).  Out of Pocket limits may be lower depending on plan.  Most plans have a schedule of copays that you will pay depending on each covered service until you reach your Maximum Out of Pocket (MOOP).

Many plans have a copay/coinsurance of 20% for chemotherapy and Part B drugs.  This is likely to be your biggest expense in a Medicare Advantage plans.

Your Part D prescription costs do NOT count toward your out of pocket maximum.