What are Medicare Advantage Plans (Part C)?
A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. 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, not Original Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.
Medicare Advantage Plans cover all Medicare services
In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care and some care in qualifying clinical research studies. Original Medicare covers hospice care and some costs for clinical research studies even if you’re in a Medicare Advantage Plan.
Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you may pay a monthly premium for the Medicare Advantage Plan
There are 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 emergency. You may also need to get a referral from your primary care doctor.
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 agree to treat you. 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.
HMO Point-of-Service (HMOPOS) plans—These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.
Medical Savings Account (MSA) plans—This is a plan that combines a high-deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. MSA plans don’t offer Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan. For more information about MSAs, visit Medicare.gov/publications to view the booklet “Your Guide to Medicare Medical Savings Account Plans.” You can also call 1‑800‑MEDICARE (1‑800‑633‑4227) to find out if a copy can be mailed to you. TTY users should call 1‑877‑486‑2048.
Make sure you understand how a plan works before you join. If you want more information about a Medicare Advantage Plan, you can call any plan and request a “Summary of Benefits” (SB) document.
How does Medicare prescription drug coverage (Part D) work?
Medicare offers prescription drug coverage to everyone with Medicare. Even if you don’t take many prescriptions now, you should consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later.To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and specific drugs covered.
There are 2 ways to get Medicare prescription drug coverage:
- Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) plans, and Medicare Medical Savings Account (MSA) plans.
- Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A, Part B, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA‑PDs.” You must have Part A and Part B to join a Medicare Advantage Plan. In either case, you must live in the service area of the Medicare drug plan you want to join.
Contact us today to learn more about coverage options. We are happy to work with you to determine which Medicare Advantage or Prescription Drug Plan may fit your needs.
Or contact www.medicare.gov, 1-800-Medicare or your State Health Insurance Assistance Program
"Medicare and You" published by the Centers of Medicare & Medicaid Services.
We do not offer every plan available on your area. Currently we represent 11 organizations which offer 96 health plans in New Jersey service areas.
Please contact Medicare.gov or 1-800-Medicare to get information on all of your plan options.
Medicare has neither reviewed nor endorsed this information