Medicare Advantage

The ABC's of Medicare

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Medicare is the US Federal Government Health Insurance Program for:

  • People 65 years of age and older.
  • Some people with disabilities under age 65.
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

 

Medicare has four parts:

Part A (Hospital Insurance)Most people do not have to pay for Part A.

 

Part B (Medical Insurance)Most people pay monthly for Part B.

 

Part C (Medicare Advantage Plans)Medicare Advantage plans are offered by private insurance companies as an alternative to Original Medicare; plans are government subsidized and regulated.

 

Part D (Prescription Drug Coverage)Part D Plans are offered by private companies to provide coverage for prescription drug costs; plans are government subsidized and regulated.

 

Medicare Advantage Breakdown

Part C (Medicare Advantage) sometimes called "Part C" or "MA Plans," are health plans offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, the plan provides all your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.

Medicare Advantage plans always cover emergency and urgent care. Medicare Advantage Plans must cover all the services that Original Medicare covers, except hospice care. (Original Medicare covers hospice care even if you're in a Medicare Advantage Plan.)

Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most plans also include Medicare prescription drug coverage.

Medicare Advantage Plans must follow rules set by Medicare. However, each 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).

You usually pay one monthly premium to the Medicare Advantage plan, in addition to your Part B premium.


Different Types of Medicare Advantage Plans

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Medical Savings Account (MSA) Plans
  • Special Needs Plans (SNP)
    Other less common types of Medicare Advantage Plans include:
  • Point of Service (POS) Plans-Similar to HMOs, but you may be able to get some services out-of-network for a higher cost.
  • Provider Sponsored Organizations (PSOs)-Plans run by a provider or group of providers. In a PSO, you usually get your health care from the providers who are part of the plan.
  • How to Join a Medicare Advantage Plan


Not all Medicare Advantage Plans work the same way, so before you join, find out the plan's rules, what your costs will be, and whether the plan will meet your needs.

Contact the specific plans you're interested in to get more information about their benefits and costs. Once you choose a plan, you may be able to join by completing a paper application, calling the plan, enrolling on the plan's Web site. Get started comparing Medicare Advantage plans in your area.