Medicare Advantage (also known as Part C)
Medicare Advantage is an all in one alternative to Original Medicare. These bundled plans include Part A, Part B, and usually Part D.
Plans may have lower out-of-pocket costs than Original Medicare.
In many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs.
Most plans offer extra benefits that Original Medicare doesn’t cover—like vision, hearing, dental, and more.
How do Medicare Advantage Plans work?
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have
Medicare is the federal health insurance program for:
- People who are 65 or older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
. These “bundled” plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).
Rules for Medicare Advantage Plans
Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
Each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services, like:
- Whether you need a to see a specialist
- If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care
These rules can change each year. That’s why help from a Medicare Specialist is so important. Don’t leave your healthcare coverage to chance or to changing rules!
Drug coverage in Medicare Advantage Plans
Most Medicare Advantage Plans include prescription drug coverage (Part D). You can join a separate Medicare Prescription Drug Plan with certain types of plans that:
- Can’t offer drug coverage (like Medicare Medical Savings Account plans)
- Choose not to offer drug coverage (like some Private Fee-for-Service plans)
You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:
- You’re in a Medicare Advantage HMO or PPO.
- You join a separate Medicare Prescription Drug Plan.
Covered services in Medicare Advantage Plans
Most Medicare Advantage Plans offer coverage for things Original Medicare doesn’t cover, like some vision, hearing, dental, and fitness programs (like gym memberships or discounts). Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness. Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees. These packages will provide benefits customized to treat specific conditions. Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations.
Costs for Medicare Advantage Plans
What you pay in a Medicare Advantage Plan depends on several factors. In many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs. Some plans won’t cover services from providers outside the plan’s network and service area.