Medicare Part C

Advantage Plans


Medicare Advantage

Medicare Advantage Plans, also known as a Medicare private health plan or Part C, are an “all in one” alternative to Original Medicare. Medicare Advantage Plans are offered by private companies who contract with the federal government. These companies are paid a fixed amount per person to provide Medicare benefits. 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 Part D (drug coverage).

The most common types of Medicare Advantage Plan are:

  • Health Maintenance Organizations (HMOs)
  • Preferred Provider Organizations (PPOs)
  • Private Fee-For-Service (PFFS)
  • Special Needs Plans (SNPs)
  • Medical Savings Accounts (MSAs)

How Part C Works

Medicare Advantage Plans work a little differently than Original Medicare. To see what’s the same and different, see The Line UP: Original Medicare vs. Medicare Advantage.

Medicare Advantage Plans may have different:

  • Provider Networks
  • Coverage rules
  • Premiums (in addition to the Part B premium)
  • Cost-sharing for covered services

Even plans of the same type offered by different companies may have different rules, so you should always check with a plan directly to find out how its coverage works.

What Part C Covers

  • Covers all your Medicare Part A and Part B approved services.
  • May include extra benefits, prescription drugs, some dental, hearing, and vision care.
  • Have annual out-of-pocket limits on covered services
  • May require you to use only in-network providers—doctors, hospitals, and suppliers.
  • Generally, a referral is needed for you to see specialists.
  • Some plans may allow you to go out-of-network for additional costs.
  • You must have Medicare Part A and Part B and live in the service plan’s geographic service area.

Join Part C

You can join a Medicare Advantage (Part C) Plan if:

  1. You have Medicare Parts A and B, and
  2. You live in the plan’s service area

Use Medicare Plan Finder tool to find a Medicare Advantage in your area. You can personalize it to include your medications, favorite pharmacies, and Medicare Advantage plan features you want.

Part C Drug coverage

Most Medicare Advantage Plans include prescription drug coverage (Part D). You can join a separate Medicare Prescription Drug Plan with certain types of plans that:

  • Can’t offer drug coverage (like Medicare Medical Savings Account plans)
  • Choose not to offer drug coverage (like some Private Fee-for-Service plans)

You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both apply:

  • You’re in a Medicare Advantage HMO or PPO, and
  • You join a separate Medicare Prescription Drug Plan

Part C Costs

Enrollees who use Medicare Advantage will still pay Part B premiums. See what the standard rate is for the Part B premium.

Your total cost will include:

+ Part A premium (if any, this is free for most enrollees)

+ Part B premium

+ Part C premium, co-pays, and deductible

 

Annual Out-of-Pocket Limit

Before you think that Part C is more expensive than Part B, remember Medicare Advantage Plans have annual out-of-pocket maximums. Once you hit that limit, you don’t have to pay any more. Not so with Original Medicare, it doesn’t matter how much you spend annually.

Deductibles & Co-Pays

Original Medicare also has deductibles. Part A has a deductible that you may pay for each hospital visit. Part B has a yearly deductible. And for both Parts A and B, you will pay an additional 20% in co-payments for hospitalizations, doctor’s and preventive services.

While Medicare Advantage plans also have deductibles and co-pays, you may find that the Medicare Advantage Plans offered in your area may limit your total annual costs, including your deductibles and co-pays, over Original Medicare.

MA Plan In-Network Providers and Service Areas

In many cases, you’ll need to use doctors and other providers who are in the Medicare Advantage plan’s network and service area, and referrals for specialists for the lowest costs. Unlike Original Medicare, most plans won’t cover services from providers outside the Medicare Advantage plan’s network and service area.

A Tool to Compare

An easy way to customize your search for a Medicare Advantage plan is to use the Medicare Plan Finder tool to find a Medicare Advantage in your area. You can personalize it to include your medications, favorite pharmacies, and Medicare Advantage plan features you want.

Learn about these factors and how to get cost details.

Medicare Supplement Insurance (Medigap) policies do NOT work with Medicare Advantage Plans

Medigap policies can’t work with Medicare Advantage Plans. Medigap policies are designed to work with Original Medicare and cannot be combined with a Medicare Advantage plan.

Learn about your options related to Medigap policies and Medicare Advantage Plans.

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