In Medicare, the term “managed care plans” refers to Medicare Advantage (Part C) plans offered by private companies contracted by Medicare. These plans work in place of your Original Medicare coverage and may cover doctors and services that Medicare doesn’t.

Managed care plans are private health insurance plans, usually Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans. In the context of Medicare, these are Medicare Part C (Medicare Advantage) plans.

These are optional coverage choices that replace Original Medicare (Part A and Part B). The plans are offered by private companies overseen by Medicare. They must cover everything Original Medicare does, and they often cover more.

This article takes a closer look at Medicare managed care plans, including types, coverage, eligibility, and cost.

You can choose from among a few kinds of Medicare Advantage or managed care plans. The plan types are similar to what you might have had in the past from your employer or the Health Insurance Marketplace.

  • HMO: An HMO is a very common health plan type that works with a network. To get your care covered, you’ll need to see providers in your plan’s network. An exception is made for emergency care; this will be covered even if you go to an out-of-network provider.
  • PPO: A PPO also works with a network. However, unlike with an HMO, you can see providers that aren’t in your network. Your out-of-pocket cost to see those providers will be higher, though, than if you see an in-network provider.
  • Health Maintenance Organization Point of Service (HMO-POS): An HMO-POS plan works with a network, like all HMO plans. The difference is that an HMO-POS plan allows you to get certain services from out-of-network providers — but you’ll likely pay a higher cost for these services than if you see an in-network provider.
  • Private Fee-for-Service (PFFS): A PFFS is a less common type of managed care plan. PFFS plans don’t have networks. Instead, for a preset price, you can see any doctor who contracts with Medicare. However, not all providers accept PFFS plans.
  • Special Needs Plan (SNP): An SNP is a managed care plan for a specific population that offers additional coverage beyond a standard plan. It is available for people with limited incomes, who are managing certain conditions, or who live in long-term care facilities.

Medicare Advantage or Part C plans replace Original Medicare, which includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

When you have A Part C plan, all your costs will be included together. You don’t need to know whether Part A or Part B will cover a service because your managed care plan will cover all the same things.

These plans also cover everything Original Medicare does, and they often cover additional services. For example, Original Medicare doesn’t cover routine dental care, but many managed care plans do.

Part C plans sometimes also include prescription drug coverage. This means that when you enroll in such a plan, you don’t need to enroll separately in Medicare Part D, and all your coverage will be included in one plan. A part C plan with drug coverage is a Medicare Advantage Prescription Drug (MAPD) plan.

Is Medigap managed care?

Medigap is not a managed care plan.

A Medigap plan, also known as Medicare supplement insurance, is an optional coverage you can add to Original Medicare to help cover out-of-pocket costs. Medigap plans can help you pay for things like:

  • coinsurance costs
  • copayments
  • deductibles

The cost of Part C or a Medicare managed care plan will depend on which plan you select, and the plans available to you will depend on where you live. Managed care plans are often specific to a state, region, or city.

You can find plans in a variety of price ranges. For example, plans in St. Louis, MO, range from $0 to $90 monthly. According to the Centers for Medicaid & Medicare (CMS), the average monthly premium for Part C plans is around $17.00 in 2025.

This cost is in addition to your cost for Original Medicare. Most people receive Part A without paying a premium, but the standard Part B premium in 2025 is $185.

So, if you select a plan with a $0 premium, you would continue to pay $185 per month. However, if you selected a $50 plan, you’d pay a total of $235 per month.

You’ll need to be enrolled in both Medicare Part A and Part B to be eligible for a managed care or Part C plan. You can become eligible for parts A and B in a few ways:

  • by turning age 65 years
  • by having a disability and receiving 2 years of Social Security Disability Insurance (SSDI)
  • by having a diagnosis of ESRD or amyotrophic lateral sclerosis (ALS)

Once you’re enrolled in Medicare parts A and B, you’ll be eligible for a managed care plan.

New Medicare managed care eligibility rules

Medicare made a few changes to its Medicare managed care plans in 2021.

One of the biggest changes was that people who are eligible for Medicare through a diagnosis of end stage renal disease (ESRD) are now able to purchase a managed care plan. Previously, they could enroll in only Original Medicare and Medicare Part D.

Another change is the addition of two special enrollment periods. This is a time outside of the yearly enrollment windows when you can change your Medicare plan. It generally includes major life changes, like moving or retirement.

You’ll also qualify for a special enrollment period if:

  • you live in a “disaster area,” as declared by the Federal Emergency Management Agency (FEMA) — for example, if your area has been struck by a hurricane or other natural disaster
  • your current health plan is a “poor performer,” according to Medicare
  • your current health plan is having financial trouble and has been placed in receivership
  • your current health plan has been sanctioned by Medicare

Other changes include a revised managed care enrollment form and the ability to sign your enrollment documents with an e-signature.

You can search for and enroll in plans in your area using Medicare’s plan finder tool.

It allows you to input your ZIP code and other personal information, like the prescriptions you take. It then matches you with plans in your area. You can sort plans by their cost to you and then look at the details for each available plan.

Once you’ve selected a plan, you can click “enroll.” The website will walk you through enrolling in the plan. You’ll need to have your red-and-white Medicare card on hand to provide information like your Medicare number and your Medicare parts A and B start date.

You can also enroll in a managed care plan directly with providers in your area. You can use their websites or call them to enroll over the phone. You can search online for insurance companies that offer Medicare managed care plans in your area.

Is a Medicare managed care plan right for you?

Questions to consider:

  • Do you need any of the extra coverage offered by plans in your area?
  • Are there plans in your area that fit your budget?
  • Is your current doctor part of the network of the plans you’re considering?
  • How often do you use your Medicare coverage?

Medicare managed care plans take the place of Original Medicare. They’re also known as Medicare Advantage or Part C plans. You can find managed care plans in HMO, PPO, HMO-POS, PFFS, and SNP formats.

Managed care plans often include additional coverage for services that Original Medicare doesn’t cover. The plans are available at a range of price points.