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Medicare Advantage Plan (Part C)

Medicare Advantage Plan (Part C)


What is a Medicare Advantage Plan or (Part C)

A Medicare Advantage Plan is offered as another Medicare health plan choice that you may have as part of Medicare. Medicare has approved these plans that are offered by private companies. If you choose to enroll in a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare Prescription Drug coverage (Part D).

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules relating to their services. These rules can change each year. (For example, rules may be whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care).


Different Types of Medicare Advantage Plans

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNP)
  • HMO Point of Service (HMOPOS) Plans— An HMO plan that may allow you to get some services out-of-network for a higher cost.
  • Medical Savings Account (MSA) Plans - A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.

(The last two bullets are less common types of

Medicare Advantage Plans that may be available)


How Much Does a Medicare Advantage Plan Cost?

In addition to your Part B premium, you usually pay one monthly premium for the services included. Each Medicare Advantage Plan can charge different out of-pocket costs. Your out-of-pocket costs in a Medicare Advantage Plan depend on:

  • If plan charges a monthly premium.
  • If the plan pays any of your monthly Part B premium.
  • If the plan has a yearly deductible or any additional deductibles.
  • How much you pay for each visit or service
  • The type of health care services you need and how often you use them.
  • If you follow the plan’s rules, like using network providers.
  • If you need extra benefits and if the plan charges for them.
  • The plan’s yearly limit on your out-of-pocket costs for all medical services.




What Does a Medicare Advantage Plan Cover?

All Medicare Advantage Plans cover emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers  - except hospice. (Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan.) Medicare Advantage Plans are not supplemental coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).


How to Join a Medicare Advantage Plan

Since Medicare Advantage Plans don’t all work the same way, it’s very important to compare available Medicare Health Plans in your area. Then once you understand the plan’s rules and costs, and you are ready to join you may either completing a paper application, call the plan, or enroll on the plan's Web site.


Additional Points on Medicare Advantage Plans

  • Enrollment is only at certain times during the yearand usually you're enrolled in a plan for a year.
  • You have all the rights and protections that Original Medicare offer.
  • Check before you receive any service to be sure it is covered by the plan and what your costs may be.
  • Be sure to follow the plans rules regarding what doctor, facility or supplier you use to avoid higher costs.
  • Even with a pre existing condition you can enroll in Medicare Advantage Plan - The only exception is End-Stage Renal Disease.
  •  If the plan decides to stop participating in Medicare, you will have to join another Medicare health plan or return to Original Medicare.






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