What is a Medicare Advantage Plan?

Medicare Advantage Plans

A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). There are several types of Medicare Advantage Plans. Each of these Medicare Advantage Plan types have special rules about how you get your Medicare covered Part A and B services and your plan’s supplemental benefits.

If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.

You must use the card from your Medicare Advantage Plan to get your Medicare covered services. Keep your red, white and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.

How do Medicare Advantage Plans work?

When you join a Medicare Advantage Plan, Medicare pays a fixed amount for your coverage each month to the company offering your Medicare Advantage Plan. Companies that offer Medicare Advantage plans must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care). These rules can change each year. The plan must notify you about any changes before the start of the next enrollment year.

If you join a Medicare Advantage Plan, you’ll have all of the same rights and protections that you would have under Original Medicare.

What do Medicare Advantage Plans cover?

Medicare Advantage Plans cover almost all Part A and Part B services. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care.

Most Medicare Advantage Plans offer coverage, for some things Original Medicare doesn’t cover, like some vision, hearing, dental, and fitness programs (like gym memberships or discounts). Plans also have a yearly limit on your out-of-pocket costs for all Part A and Part B medical services. Once you reach this limit, you’ll pay nothing for services Part A and Part B cover.

Medicare drug coverage (Part D)

Most Medicare Advantage Plans include Medicare drug coverage (Part D). In certain types of plans that don’t include Medicare drug coverage (like Medical Savings Account Plans and some Private-Fee-for-Service Plans), you can join a separate Medicare drug plan.

Note: If you’re in a plan that doesn’t offer drug coverage, and you don’t have a
Medicare drug plan, you may have to pay a late enrollment penalty if you decide to
join a Medicare drug plan.

Who can join a Medicare Advantage Plan?

To join a Medicare Advantage Plan you must:
• Have Part A and Part B.
• Live in the plan’s service area.

Things to consider when choosing a Medicare Advantage Plan

  • What is my Maximum Out of Pocket Responsibility
  • Are my doctors in the Network
  • Are my Prescriptions Covered
  • What are my copays and deductibles
  • Should I choose an HMO or PPO
  • Coverage while traveling

Compare Medicare Advantage Plans in your area

Is a Medicare Advantage Plan Right for you?