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 from the Medicare system – although you are still enrolled in Medicare.
Medicare pays a fixed amount to private insurance companies offering Medicare Advantage Plans and these companies must follow the rules set forth by Medicare. Medicare Advantage Plans will sometimes include additional benefits and will have a different structure of co-payments, and deductibles but essentially the “Base Value” is equivalent to Medicare alone. Medicare Advantage Plans are not Medicare supplemental insurance plans a.k.a. Medigap which is another category of its own.
It’s important to note that not all Medicare Advantage Plans work the same way. Most have varying co-pays for each event category I.e. Primary Care Office visit, Specialist Office visit, and/or a hospital stay just to name a few. Most will have some sort of network of doctors like and HMO and you may not be able to see providers outside of these networks – except in the case of emergencies where all plans are required to cover emergency services. You need to review each plan’s Summary of Benefits before joining.
Once you understand parts A, B, C and D, or, C/D combinations you have the basics. See the info for Part A, Part B, Part C and Part D for more details. If you still have questions, you can request a free Medicare phone consultation at 610-399-8700.
Covered services in Medicare Advantage Plans
Medicare Advantage Plans cover all Medicare services. Medicare Advantage Plans may also offer extra 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.
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 Advantage Plans
What you pay in a Medicare Advantage Plan depends on several factors;
Whether the plan charges a monthly premium.
Whether the plan pays any of your monthly Medicare Part B (Medical Insurance) premium.
Whether the plan has a yearly deductible or any additional deductibles.
How much you pay for each visit or service (copayment or coinsurance). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.
The type of health care services you need and how often you get them.
Whether you go to a doctor or supplier who accepts assignment (if you’re in a PPO, PFFS, or MSA plan and you go out-of-network).
Whether you follow the plan’s rules, like using network providers.
Whether you need extra benefits and if the plan charges for it.
The plan’s yearly limit on your out-of-pocket costs for all medical services.
Whether you have Medicaid or get help from your state.
Drug coverage in Medicare Advantage Plans
You usually get prescription drug coverage (Part D) through the plan. In some types of plans that don’t offer drug coverage, you can join a Medicare Prescription Drug Plan.
You can’t have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. If you’re in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.