Part C, Medicare Advantage | Medicare Advocates

MEDICARE ADVANTAGE PLANS A Medicare Advantage Plan is a type […]

June 16, 2021



A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all 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, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

How do Medicare Advantage Plans work?

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Medicare Advantage Plans cover all Medicare services

Medicare health plans provide Part A and Part B benefits to people with Medicare who enroll in these plans, which include Medicare Advantage Plans, Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE).

Medicare Advantage Plans must follow Medicare’s rules

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.

However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only 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 health plans

Find out what factors contribute to how much you pay out-of-pocket when you have a Medicare health plan.

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Medicare Advantage plans

If you receive your Part A and Part B benefits directly from the government, you have Original Medicare. If you receive your benefits from a Medicare Advantage organization or other private company approved by Medicare, you have a Medicare Advantage plan. Many of these plans provide extra coverage and may lower your out-of-pocket costs. 

If you have Medicare Parts A and B, you can join a Medicare Advantage plan. With these plans, you can’t have a Medigap policy, because Medicare Advantage plans cover many of the same benefits a Medigap policy covers. This includes benefits like extra days in the hospital after you’ve used the days that Medicare covers. 

Medicare Advantage plans include all of the following: 

  • Health Maintenance Organization (HMO) plans. You must get your care and services from doctors and other healthcare providers in the plan’s network except in the case of an emergency. These are usually managed care plans where your Primary Care Physician is at the center of your health plan.
  • Preferred Provider Organization (PPO) plans.  These plans offer the same general benefits as an HMO (meaning there is still an “in network” panel of doctors and hospitals, but you will have more options to get care out of network and across state lines.
  • Private Fee-for-Service (PFFS) plans.  This is a Medicare Advantage (MA) health plan, offered by a State licensed risk bearing entity, which has a yearly contract with the Centers for Medicare & Medicaid Services (CMS) to provide beneficiaries with all their Medicare benefits, plus any additional benefits the company decides
  • Special Needs Plans (SNPs). Medicare SNPs are Medicare Advantage plans that include RX coverage and limit membership to people with specific diseases or characteristics or Medicaid eligibility. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.

If you decide to join a Medicare Advantage plan, you use the health card that you get from your Medicare Advantage plan provider for your health care. Also, you might have to pay a monthly premium for your Medicare Advantage plan because of the extra benefits it offers.

You can enroll in a Medicare Advantage plan during your Initial Enrollment Period (IEP), as explained under the “Signing up for Medicare” section, the first time you’re eligible for Medicare. You can also enroll during the annual Medicare open enrollment period from October 15 to December 7 each year. The effective date for the enrollment is January 1 of the following year. For example, if you signed up on November 8, 2021, your coverage would become active on January 1, 2022. There are also special enrollment periods for some situations.

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Call us today at 1-800-940-0633