What is Medicare Advantage?

Medicare Advantage plans, sometimes called "Medicare Part C" or "MA Plans," are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare.  The insurance companies sign a one year contract with the Medicare to offer you an alternative to original Medicare. If you join a Medicare Advantage plan, you still have Medicare.  These "bundled" plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare prescription drug (Part D).

There are different kinds of Medicare Advantage plans:

  • Health Maintenance Organizations / HMO
  • Preferred Provider Organizations / PPO
  • Private Fee-for-Service Plans / PFFS
  • Special Needs Plans / SNP
  • Medicare Medical Savings Account Plans / MSA

Medicare Advantage plans cover all Medicare services.  Some Medicare Advantage plans also offer extra coverage, like vision, hearing and dental coverage.

If you are enrolled in a Medicare Advantage plan:

  • Most Medicare services are covered through the plan (exception hospice)
  • Medicare services are not paid by Original Medicare
  • They are NOT a Medicare Supplement

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 referral 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 and benefits can change each year.

How Medicare Supplement Insurance (Medigap) policies work with Medicare Advantage plans

Medigap policies can't work with Medicare Advantage Plans.  You would choose a Medicare Supplement OR a Medicare Advantage Plan.

What You Pay in a Medicare Advantage Plan

  • Whether the plan charges a monthly premium. Some plans have no premium.
  • Whether the plan has a yearly deductible or any additional deductibles.
  • How much you pay for each visit or service ( copayment or coinsurance ). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.
  • The type of health care services you need and how often you get them.
  • Whether you follow the plan's rules, like using network providers.
  • Whether you need extra benefits and if the plan charges for it.
  • The plan's yearly out-of-pocket costs for all medical services.
  • Whether you have Medicaid or get help from your state.
  • What prescriptions are covered and not covered.

Note

Each year plans set the amounts they charge for premiums, deductibles, and services. The plan (rather than Medicare) decides how much you pay for covered services. 

Get more cost details from your plan

If you're in a Medicare plan, review the notices you receive each fall:

  • Evidence of Coverage (EOC) gives you details about what the plan covers, how much you pay, and more.
  • Annual Notice of Change (ANOC). The ANOC includes any changes in coverage, costs, or service area that will be effective in January.

If you do not get these important documents, contact us and we can help.

IMPORTANT – because these plans change from year to year, we encourage you to contact us for help to review your plan.