Medicare Advantage Plans

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.  These plans operate almost identically to the kind of health insurance you have had your whole life individually or through work, and usually cover you better than those.  Most MA plans are set up in HMO and PPO structures, similar to what you've had in the past, except these plans don't have deductibles you need to hit before they start protecting you. 

If you join a Medicare Advantage Plan, you still have Medicare. You still need to have Part A and Part B through the government, but the provider you choose will become the primary payor instead of 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.

Drug coverage in Medicare Advantage Plans

You usually get prescription drug coverage through the plan. Every plan has a different drug formulary!  It is important that we help you choose a plan that covers the prescriptions you're on at the best price possible.

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.