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
- 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.