Medicare Advantage (Part C) Plans
Medicare Advantage (also called Medicare Part C) plans are all-in-one plans that combine the coverage of Original Medicare (Part A and Part B) with extra benefits you can’t get from Medicare alone. Most also include Part D prescription drug coverage and may also offer additional benefits such as dental, vision, hearing and fitness. These are often provided with no additional premium charge.
Medicare Advantage plans operate within defined geographic areas called service areas. You must live in a plan’s service area to become a plan member, and a plan’s coverage and costs can vary by plan and location.
What do Medicare Advantage (Part C) plans cover?
All Medicare Advantage Plans Cover:
- All the benefits of Part A (hospice coverage may be provided, but if not, will still be covered by Part A)*
- All the benefits of Part B
Most Medicare Advantage Plans Cover:
- Prescription drugs
Additional Benefits Medicare Advantage Plans May Offer:
- Dental exams, cleanings and X-rays
- Eye exams, eyeglasses and corrective lenses
- Hearing tests and hearing aids
- Wellness programs and fitness memberships
- Other extra benefits such as transportation to medical appointments and virtual provider visits
*Even if you have a Medicare Advantage plan, hospice care will still be paid for you by Original Medicare Part A.
Important things to note about Medicare Advantage plans
- Some plans will have provider networks, some will not
- Out-of-pocket cost limitations can vary by plan
- Plan premiums can vary by plan, with different ones offered to fit different budgets
What types of Medicare Advantage (Part C) plans are there?
Coordinated Care Plans
Most Medicare Advantage plans are coordinated care plans. Coordinated care plans have a network of providers. If you use the plan’s network providers, you generally pay less out-of-pocket for care.
Health Maintenance Organization (HMO) plans
- HMO plans use a network primary care provider to help coordinate care. HMO plans usually only pay for providers in the plan network.
Point of Service (POS) plans
- POS plans have the benefits of an HMO, but with more flexible provider choice. Costs are generally lower for using in-network providers.
Preferred Provider Organization (PPO) plans
- PPO plans cover providers both in and out of network. These plans pay a portion of the cost for using an out-of-network provider.
Special Needs Plans (SNPs)
Special Needs Plans have benefits that cover special health care or financial needs. All SNPs include prescription drug coverage.
- Dual-Eligible Special Needs Plans (D-SNPs) for people who have both Medicare and Medicaid (called “dual eligible”)
- Chronic Special Needs Plans (C-SNPs) for people living with severe or disabling chronic conditions
- Institutional Special Needs Plans (I-SNPs) for people who live in a skilled nursing facility
- Institutional-Equivalent Special Needs Plans (IE-SNPs) for people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility
Other types of Medicare Advantage (Part C) Plans
- If you want more freedom in health care providers or payment options, there are two other types of Medicare Advantage plans to consider.
Private Fee-For-Service (PFFS) plans
- PFFS plans may or may not have a provider network, but cover any provider who accepts Medicare. If the plan doesn’t include prescription drug coverage, you can also enroll in a stand-alone Part D plan separately.
Medical Savings Account (MSA) plans
- MSA plans combine a high-deductible health plan with a special savings account. Medicare deposits funds that are withdrawn tax free to pay for qualified health care services. You can see any provider you choose. MSA plans don’t cover prescription drugs, but you can enroll in a stand-alone Part D plan separately.
What does Medicare Part C cost?
Each Medicare Advantage (Part C) plan sets its own specific costs, but the types of costs they include are similar. The table below shows the types of costs that plans may apply, but you need to look at the details of a particular plan for actual costs.
| Premium | Deductible | Copayment | Coinsurance | |
|---|---|---|---|---|
| Frequency | Per month | Per year | Upon most medical services, such as doctor visits | For select items, such as durable medical equipment |
| Details | Plan premiums vary. You still pay the Part B premium to Medicare (and the Part A premium, if you have one). | Some plans charge an annual deductible, and some do not. Medicare Part A and Part B deductibles do not apply. | Many plans charge copays for the services and benefits you use. | Plans set their own coinsurance terms and percentages. |
How Medicare Advantage cost sharing works
Most Medicare Advantage plans use a combination of deductibles, co-insurance and co-pays to share the cost of the services you use. Cost-sharing usually applies to all the services the plan covers.
You need to read the details of each individual Medicare Advantage plan to get the full story on its costs. Most plans have network doctors and pharmacies that may offer plan members discounted pricing.
