Medicare Advantage (Part C)

A Medicare Advantage plan (like an HMO or PPO) is another way to get your Medicare coverage. Medicare Advantage, sometimes called “Part C” or “MA”, plans are offered by private companies approved by Medicare. Medicare Advantage plans cover all Medicare Part A and Part B benefits. Many MA plans also offer extra benefits that Medicare does not cover. Generally, you will get your services from a plan’s network of providers. In most cases, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services.

What Do Medicare Advantage Plans Cover?

Medicare Advantage plans must cover all of the services that Original Medicare covers except hospice care. (Original Medicare covers hospice care, even if you are in a MA plan). In all types of Medicare Advantage plans, you’re always covered for emergency and urgent care services. Additionally, MA plans can choose not to cover the costs of services that aren't medically necessary under Medicare.

 

Unlike Original medicare, all MA plans must include a limit on your out-of-pocket expenses for Part A and Part B services. Medicare Advantage plans may offer extra coverage, like vision, hearing, dental, and other health and wellness programs. Some plans include Medicare prescription drug coverage (MA-PD). In addition to your Part B premium, you might pay a monthly premium for the Medicare Advantage plan.

 

Medicare Advantage Plans Must Follow Medicare's Rules

Medicare pays a fixed amount for your coverage each month to the companies offering Medicare Advantage plans. These companies must follow rules set by Medicare. However, each MA 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 doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care). These rules can change each year. The plan must notify you about any changes before the start of the next enrollment year. Remember, you have the option each year during Open Enrollment to keep your current plan, choose a different plan, or switch to Original Medicare.

 

What Are The Different Types Of Medicare Advantage Plans?

Health Maintenance Organization (HMO) plans—In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network except in an urgent or emergency situation. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.

Preferred Provider Organization (PPO) plans—In a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside of the network.

Private Fee-for-Service (PFFS) plans—PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Special Needs Plans (SNPs)—SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.

 

Prescription Drug Coverage

You usually get prescription drug coverage (Part D) through the Medicare Advantage plan. In certain types of MA plans (PFFS or MSA plans) that don’t offer drug coverage, you can join a Medicare Prescription Drug Plan. If your Medicare Advantage plan includes prescription drug coverage and you join a Medicare Prescription Drug plan, you’ll be disenrolled from your Medicare Advantage plan and returned to Original Medicare.

 

When Can I Join, Switch, Or Drop A Medicare Advantage Plan?

When you first become eligible for Medicare, you can sign up during your Initial Enrollment Period.

If you have Part A coverage and you get Part B for the first time during the General Enrollment Period, you can also join a Medicare Advantage Plan.

Between October 15–December 7 anyone with Medicare can join, switch, or drop a MA plan. Your coverage will begin on January 1, as long as the plan gets your request by December 7.

 

Can I Make Changes To My Coverage After December 7th?

Between January 1–February 14, if you’re in a Medicare Advantage plan, you can leave that plan and switch to Original Medicare. If you switch to Original Medicare during this period, you’ll have until February 14 to also join a Medicare Prescription Drug plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment request. During this period, you can’t:

Switch from Original Medicare to a Medicare Advantage plan.

Switch from one Medicare Advantage plan to another.

Switch from one Medicare Prescription Drug plan to another.

Join, switch, or drop a Medicare Medical Savings Account plan

 

Special Enrollment Periods

In most cases, you must stay enrolled for the calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period. Some examples are:

You move out of your plan’s service area.

You have Medicaid.

You qualify for Extra Help.

You live in an institution (like a nursing home).

Medicare Advantage (Part C)

A Medicare Advantage plan (like an HMO or PPO) is another way to get your Medicare coverage. Medicare Advantage, sometimes called “Part C” or “MA”, plans are offered by private companies approved by Medicare. Medicare Advantage plans cover all Medicare Part A and Part B benefits. Many MA plans also offer extra benefits that Medicare does not cover. Generally, you will get your services from a plan’s network of providers. In most cases, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services.

What Do Medicare Advantage Plans Cover?

Medicare Advantage plans must cover all of the services that Original Medicare covers except hospice care. (Original Medicare covers hospice care, even if you are in a MA plan). In all types of Medicare Advantage plans, you’re always covered for emergency and urgent care services. Additionally, MA plans can choose not to cover the costs of services that aren't medically necessary under Medicare.

 

Unlike Original medicare, all MA plans must include a limit on your out-of-pocket expenses for Part A and Part B services. Medicare Advantage plans may offer extra coverage, like vision, hearing, dental, and other health and wellness programs. Some plans include Medicare prescription drug coverage (MA-PD). In addition to your Part B premium, you might pay a monthly premium for the Medicare Advantage plan.

 

Medicare Advantage Plans Must Follow Medicare's Rules

Medicare pays a fixed amount for your coverage each month to the companies offering Medicare Advantage plans. These companies must follow rules set by Medicare. However, each MA 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 doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care). These rules can change each year. The plan must notify you about any changes before the start of the next enrollment year. Remember, you have the option each year during Open Enrollment to keep your current plan, choose a different plan, or switch to Original Medicare.

 

What Are The Different Types Of Medicare Advantage Plans?

Health Maintenance Organization (HMO) plans—In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network except in an urgent or emergency situation. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.

Preferred Provider Organization (PPO) plans—In a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside of the network.

Private Fee-for-Service (PFFS) plans—PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Special Needs Plans (SNPs)—SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.

 

Prescription Drug Coverage

You usually get prescription drug coverage (Part D) through the Medicare Advantage plan. In certain types of MA plans (PFFS or MSA plans) that don’t offer drug coverage, you can join a Medicare Prescription Drug Plan. If your Medicare Advantage plan includes prescription drug coverage and you join a Medicare Prescription Drug plan, you’ll be disenrolled from your Medicare Advantage plan and returned to Original Medicare.

 

When Can I Join, Switch, Or Drop A Medicare Advantage Plan?

When you first become eligible for Medicare, you can sign up during your Initial Enrollment Period.

If you have Part A coverage and you get Part B for the first time during the General Enrollment Period, you can also join a Medicare Advantage Plan.

Between October 15–December 7 anyone with Medicare can join, switch, or drop a MA plan. Your coverage will begin on January 1, as long as the plan gets your request by December 7.

 

Can I Make Changes To My Coverage After December 7th?

Between January 1–February 14, if you’re in a Medicare Advantage plan, you can leave that plan and switch to Original Medicare. If you switch to Original Medicare during this period, you’ll have until February 14 to also join a Medicare Prescription Drug plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment request. During this period, you can’t:

Switch from Original Medicare to a Medicare Advantage plan.

Switch from one Medicare Advantage plan to another.

Switch from one Medicare Prescription Drug plan to another.

Join, switch, or drop a Medicare Medical Savings Account plan

 

Special Enrollment Periods

In most cases, you must stay enrolled for the calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period. Some examples are:

You move out of your plan’s service area.

You have Medicaid.

You qualify for Extra Help.

You live in an institution (like a nursing home).