Types of Medicare Plans Explained

Medicare Plan Types: Side-by-Side Comparison

The table below compares all four Medicare plan types across the features that matter most: coverage scope, monthly costs, out-of-pocket maximums, network rules, and who each plan type serves best.

Original Medicare (Parts A and B)

Original Medicare is the federal health insurance program administered directly by the government. It consists of two parts that work together to cover most medical services.

Medicare Advantage Plans (Part C)

Medicare Advantage plans are offered by private insurance companies approved by Medicare. They provide all Part A and Part B benefits through a managed care network, and most plans bundle prescription drug coverage (MAPD) along with extra benefits like dental, vision, hearing, and fitness programs.

• Annual out-of-pocket maximum of $9,250 for in-network services (2026)
• Often $0 additional monthly premium beyond Part B
• Extra benefits not covered by Original Medicare (dental, vision, hearing)
• Network restrictions - must use plan providers (HMO) or pay more (PPO)
• Prior authorization required for many services

You must continue paying your Part B premium ($202.90/month in 2026) in addition to any Medicare Advantage plan premium. Learn more about the full cost breakdown and how it compares to Original Medicare.

Medicare Advantage Plan Types: HMO, PPO, PFFS, and SNP

Within Medicare Advantage, there are four main plan structures. Each uses a different approach to provider networks, referrals, and cost-sharing.

• HMO

  Health Maintenance Organization

  Lower costs with a defined network. Requires a primary care physician and referrals for specialists. Out-of-network care is not covered except in emergencies.

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• PPO

  Preferred Provider Organization

  More flexibility to see any Medicare-accepting provider without referrals. In-network care costs less, but out-of-network care is still partially covered.

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• PFFS

  Private Fee-for-Service

  No fixed network - you can see any Medicare-accepting provider who agrees to the plan's payment terms. Availability varies by region.

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• SNP

  Special Needs Plan

  Tailored benefits for people with specific chronic conditions, dual eligibility (Medicare + Medicaid), or institutional care needs.

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Medicare Supplement Plans (Medigap)

Medigap plans are standardized supplemental insurance policies sold by private companies that help pay the out-of-pocket costs left by Original Medicare - deductibles, coinsurance, and copayments. They do not replace Medicare; they work alongside it.

• Standardized plans (A, B, C, D, F, G, K, L, M, N) - same benefits regardless of insurer
• Works with any doctor or hospital that accepts Medicare nationwide
• Predictable costs - most plans cover 100% of gaps after deductible
• No network restrictions, no referrals, no prior authorization
• Does not include prescription drug coverage (need separate Part D)
• Monthly premiums higher than Medicare Advantage

The most popular Medigap plans in 2026 are Plan G and Plan N. Plan G covers everything except the Part B deductible ($283 in 2026), while Plan N has lower premiums but includes small copays for office visits.

Guaranteed issue rights for Medigap are strongest during your Medigap Open Enrollment Period - the 6-month window starting when you turn 65 and enroll in Part B. After this window, insurers can use medical underwriting to deny coverage or charge higher premiums.

Medicare Part D (Prescription Drug Coverage)

Medicare Part D provides prescription drug coverage through private insurance plans approved by Medicare. You can get Part D coverage either as a standalone plan (paired with Original Medicare) or bundled within a Medicare Advantage plan (MAPD).

Each Part D plan has its own formulary (list of covered drugs) organized into cost-sharing tiers. Before enrolling, check that your specific medications are covered and at what tier level. Learn more about how Part D formularies work.

How to Choose the Right Medicare Plan Type

Choosing between plan types comes down to four factors: your health needs, your preferred doctors, your medications, and your budget tolerance for unexpected costs.

For a detailed comparison, read our guide on Medigap vs. Medicare Advantage to see how costs, coverage, and flexibility compare in real-world scenarios.

Frequently Asked Questions