Medicare Advantage (Part C)

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​Medicare Advantage (also known as Part C)

A type of Medicare health plan offered by a private company that contracts with Medicare.
Medicare Advantage Plans provide all of your Part A and Part B benefits. Medicare Advantage
Plans include:

  • Health Maintenance Organizations
  • Preferred Provider Organizations
  • Private Fee-for-Service Plans
  • Special Needs Plans
  • Medicare Medical Savings Account Plans

If you’re enrolled in a Medicare Advantage Plan:

  • Most Medicare services are covered through the plan
  • Medicare services aren’t paid for by Original Medicare

​Most Medicare Advantage Plans offer prescription drug coverage

​Medicare Advantage – Different types of plans

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A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits. Medicare Advantage Plans include:

  • Health Maintenance Organizations
  • Preferred Provider Organizations
  • Private Fee-for-Service Plans
  • Special Needs Plans
  • Medicare Medical Savings Account Plans


If you’re enrolled in a Medicare Advantage Plan:

  • Most Medicare services are covered through the plan
  • Medicare services aren’t paid for by Original Medicare

Who can join a Medicare Advantage Plan?

You can generally join one of these Medicare Advantage plans:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-for-Service (PFFS)
  • Medical Savings Account (MSA) Plan

If all of these apply:

  • You live in the service area of the plan you want to join. The plan can give you more information about its service area. If you live in another state for part of the year, ask if the plan will cover you there.
  • You have Medicare Part A and Part B.
  • You don’t have End-Stage Renal Disease (ESRD).

How do Medicare Advantage Plans Work?

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​Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all in one” alternative to Original Medicare. They are offered by private companies approved by 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).

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

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 can change each year.

Costs for Medicare Advantage Plans
What you pay in a Medicare Advantage Plan depends on several factors. 

Drug coverage in Medicare Advantage Plans
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 of these apply:

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

How Medicare Supplement Insurance (Medigap) policies work with Medicare Advantage Plans
Medigap policies can’t work with Medicare Advantage Plans.


Source:www.medicare.gov