MEDICARE PART C
(MEDICARE ADVANTAGE)
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 Part D (Medicare drug coverage)
PART C (MEDICARE ADVANTAGE) COVERED SERVICES
Most Medicare Advantage Plans offer coverage for things Original Medicare doesn’t cover, like
some vision
hearing
dental
fitness programs (like gym memberships or discounts)
Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services like
transportation to doctor visits
over-the-counter drugs
services that promote your health and wellness.
Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees
These packages will provide benefits customized to treat specific conditions.
Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations.
PART C (MEDICARE ADVANTAGE) 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.
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.
PART C (MEDICARE ADVANTAGE) COSTS
What you pay in a Medicare Advantage Plan depends on several factors.
In many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs.
Some plans won’t cover services from providers outside the plan’s network and service area.
PART C (MEDICARE ADVANTAGE) DRUG COVERAGE
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 un-enrolled 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.