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Medicare Part C – Medicare Advantage

Medicare Advantage plans combine Original Medicare (Parts A and B) into one plan and include additional benefits. These plans, sometimes called Part C or MA plans, are offered by private insurance companies approved by Medicare. The premiums are a flat rate, regardless of age.

All Medicare Advantage plans provide:

  • Medicare Part A (hospital insurance) coverage
  • Medicare Part B (medical insurance) coverage
  • Limits on the out-of-pocket costs you pay

Most include:

  • Medicare prescription drug coverage (Part D)
  • Provider networks to help manage costs
  • Extra coverage, such as vision, hearing, dental, and/or health and wellness programs

All Medicare Advantage plans cover:

  • Emergency and urgent care
  • Hospice care (covered by Original Medicare)

Plans can charge different copays, coinsurance and deductibles for these services.

Depending on the Medicare Advantage plans offered in your area, you may have these options:

  • HMO – Health Maintenance Organization
    With most HMO plans, you can only go to doctors, specialists or hospitals within the plan's network, except in an emergency. You may also be required to get a referral from your primary care doctor prior to visiting a specialist.
  • HMO-POS – HMO Point of Service Plan
    This HMO plan allows you to get some services out of network for a higher cost.
  • PPO – Preferred Provider Organization
    With most PPO plans, you pay less if you use doctors, hospitals and other health care providers that belong to the plan's network. You can use doctors, hospitals and providers outside of the network, but you may pay higher copays and coinsurance.
  • PFFS – Private Fee for Service
    PFFS plans are like Original Medicare in that you can generally go to any doctor, health care provider or hospital if they agree to treat you. A PFFS plan determines how much it will pay doctors, health care providers and hospitals, and how much you must pay when you get care.
  • SNP – Special Needs Plan
    SNPs provide focused and specialized health care for specific groups of people, such as those who have both Medicare and Medicaid, who live in a nursing home, or have certain chronic medical conditions.
  • MSA – Medical Savings Account
    An MSA plan combines a high-deductible health plan with a bank account. Medicare deposits money directly into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.

Important Things to Remember

You Must Continue to Pay Your Part B Premium

If you enroll in a Medicare Advantage plan, you will need to continue paying your Medicare Part B premium as well as any premium charged by the plan you choose. A monthly premium may apply and can vary based on the plan selected.

You Can’t Have a Medicare Supplement Insurance Plan and a Medicare Advantage Plan at the Same Time

Medicare Advantage plans are health insurance plans approved by Medicare and offered by private companies. Medicare Advantage plans are different from Medicare Supplement Insurance Plans. If you enroll in a Medicare Advantage plan, you cannot purchase a Medicare Supplement Insurance Plan.

 

Play this video to learn about signing up for Medicare Part C.

  • Read Transcript

    Part C (Medicare Advantage)

     

    What is it?

    Medicare Part A and Part B make up what is sometimes called "Original Medicare." While Parts A and B are helpful, most people who are Medicare eligible buy more insurance. Let's look at Part C, or Medicare Advantage plans, which are offered by private insurance companies.

    Unlike Original Medicare, a Medicare Advantage plan often has different rules for how you get services or which medical providers you can see. You pay a monthly premium for Part C coverage.

    So what's the advantage?

    Private insurance companies that offer Part C usually offer other benefits, such as hearing, dental and wellness programs. Some Medicare Advantage plans offer coverage for prescription drugs. Because there are many differences between Part C plans, you should take your time to shop and compare.

    What are the details?

    You can enroll in a Medicare Advantage plan when you first become eligible for Medicare. The Initial Enrollment Period starts three months before the month of your 65th birthday and ends three months after your birthday month. To be eligible, you must live in the area where the Medicare Advantage plan is being offered. You can switch plans from October 15 through December 7 during the Annual Enrollment Period. In most cases, you will stay enrolled for the calendar year starting from the date your coverage begins. But sometimes you can change your Medicare Advantage plan. If you move or lose your insurance coverage, you may be able change your plan during a Special Enrollment Period.

    • If you're a citizen or permanent resident of the United States age 65 or older, you can still enroll in Medicare Part A even if your full Social Security retirement age is not 65.
    • If you're getting Social Security or Railroad Retiree benefits, you will be signed up for Medicare Part A without having to do anything.
    • If you work past age 65 for a company with 20 or more full-time employees, you can use your company's plan as your main coverage.

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