When it comes to Medicare, you have the power to choose

Find out what each type of plan covers, and which one could be right for your needs. 

If Medicare feels confusing, you are not alone. You have options, and this guide will help you understand them so you can make the best choice for your health and your life.

New to Medicare? Start here. Looking for tips to help you select a health plan? This article is for you.

What are your Medicare options?

You have two main types of Medicare coverage:

1. Original Medicare

• This includes Part A (hospital care) and Part B (doctor visits)
• You can use any doctor or hospital that takes Medicare
• You usually pay a monthly premium and a share of the costs when you get care
• It does not include dental, vision or hearing
• It does not include drug coverage unless you add a separate Part D plan

2. Medicare Advantage

• Also called Part C
• Offered by private insurance companies that follow Medicare rules
• Most plans include Part D drug coverage
• Often includes dental, vision and hearing benefits
• May include extra benefits like transportation or fitness programs
• Has a yearly cap on out-of-pocket costs

Why people choose Medicare Advantage

Medicare Advantage plans can give you:

• Access to fitness programs like SilverSneakers^®
• Coverage for dental, vision and hearing and optional prescription drugs on many plans
• Some plans may include monthly allowance for over-the-counter products like vitamins, supplements and medical devices*
• Wellness programs like Go365^® to encourage healthy habits
• Some plans include transportation benefits to help with getting to and from the doctor
• Telehealth services included on some plans†

These plans may also be able to help you save money with low or $0 monthly premiums, set copays and a limit on what you pay each year.

What is value-based care?

Value-based care means doctors are paid to help you improve your health—not just for how many services they provide. This kind of care could offer you:ⁱ

• A care team that helps with prescriptions, check-ins and follow-ups
• More time with your doctor
• Help managing long-term health issues
• Fewer emergency room visits and hospital stays
• Lower costs overall

Humana has shown that members in value-based care settings receive higher rates of preventative screenings, fewer emergency room and hospital admissions and greater adherence to medications than those in non-value-based care settings, all of which contribute to lower medical costs. Your health plan should be a doorway to the right care for you.

See if your Medicare Advantage plan includes value-based providers in its network.

Choosing between HMO and PPO plans

There are different types of Medicare Advantage plans. The 2 most common are HMO and PPO.

Health Maintenance Organization (HMO) plans:

• You must use doctors in the plan’s network who have agreed to accept payment at a certain level for any services they provide
• You must choose a primary care doctor (PCP) when you enroll in a plan
• You need a referral from your PCP to see a specialist
• This plan is best if you don’t need many specialists visits

HMO perks:

• Affordability, because the HMO network allows the plan to keep costs in check for members
• Your PCP is your medical home base and the central person in charge of your healthcare

You might enroll in an HMO if you are someone who doesn’t need much specialist care. Learn more about HMOs.

Preferred Provider Organization (PPO) plans:

• Offers a network of healthcare providers who have agreed to provide care at a certain rate
• More flexibility to receive care from any provider in or out of the network
• You may have higher premiums and copays, and there is an annual deductible that must be met

PPO perks:

• You do not have to select a PCP when joining
• No referrals are required to go to any doctor, specialist or hospital

You might enroll in a PPO if you want more control over your choices and don’t mind paying for that flexibility. Learn more about PPOs.

You can also compare HMOs and PPOs in this chart to help figure out which is right for your needs.

Special Needs Plans (SNPs)

Some Medicare Advantage plans are made for people with specific needs. Learn more about Humana SNPs.

Chronic Condition Special Needs Plans (C-SNPs):

They are for people with long-term health conditions including diabetes, heart problems or kidney disease. They offer more support, such as a team that helps manage your care. If you need a C-SNP, you may also want to consider a value-based care provider who can offer additional services and support from a team of healthcare professionals led by a primary care provider.

Learn more about C-SNPs here.

Dual-eligible SNPs (D-SNPs):

D-SNPs‡ are for people who qualify for both Medicare and Medicaid. Medicaid is another federal health insurance program that provides coverage to individuals and families with low incomes. It may cover:

• Doctor visits
• Hospital stays
• Long-term medical care
• Non-medical daily basic care (such as help with eating, bathing, dressing, etc.)
• Dental care

A D-SNP coordinates Medicare and Medicaid benefits under one plan by giving members access to providers not typically covered by Medicaid, offering many plans with $0 and low-cost premiums and prescription drug coverage.

Get even more support with value-based care

Many people with a C-SNP or D-SNP find even more help when they choose a value-based care provider. These doctors may offer transportation, on-site services, like lab work and dental care, or provide access to a health coach or behavioral health support.

The right plan should lead to the right care for you

Medicare is not one-size-fits-all. Whether you choose Original Medicare or a Medicare Advantage plan, the goal is the same—good care that fits your needs. Learn more about what the right kind of care looks like.