Medicare Advantage Plans

What Is a Medicare Advantage Plan (PART C)?

Medicare Advantage Plans are provided through private insurance companies that have been approved by the government. They offer coverage for both Medicare Part A and Medicare Part B services, with a maximum out-of-pocket charge to the insured.

There are several different Medicare Advantage plans to choose from, including:

Health Maintenance Organization (HMO) Plans

Most HMO plans require you to use doctors and health care providers within their network, except in the event of an emergency. You may need a referral to see doctors and specialists outside your HMO plan’s network.

Preferred Provider Organization (PPO) Plans

A PPO plan allows you to pay less for using doctors and health care providers within the plan’s network. Doctors and health care providers who work outside the network can be used, but at a higher cost. Typically, Medicare PPO plans provide more benefits than Original Medicare, though at an additional cost.

Who Is Eligible to Join a Medicare Advantage Plan?

Enrollment in Medicare Part A and Part B is required to join a Medicare Advantage Plan, as is living in the plan’s service region.

How Much Do Medicare Advantage Plans Cost?

Medicare Advantage Plans usually charge a monthly premium, in addition to the Medicare Part B premium. The cost varies from plan to plan, so evaluating and weighing the benefits of each is important before you join one.

What Do Medicare Advantage Plans Cover?

Although they have a different copay structure, Medicare Advantage Plans are required to provide the same coverage as Original Medicare (Medicare Part A & Part B), with the exception of hospice care. All plans must cover emergency care both within their service areas and outside of them (within the U.S.). Most plans offer Medicare Part D (Prescription Drug Coverage), as well as additional benefits, such as dental, hearing, vision, and other health programs. If your Medicare Advantage Plan does not include drug coverage, you cannot enroll in Medicare Part D additionally.

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