Medicare Part C Is Called Medicare Advantage

Key Points About Medicare Advantage Plans

Here are a few important highlights about how Medicare Advantage works.

What is Medicare Advantage or Medicare Part C?

Medicare Advantage plans combine Original Medicare (Parts A and B) into one plan and include additional benefits. These plans, sometimes called Part C or MA Plans, are offered by private insurance companies approved by Medicare. The premiums are a flat rate, regardless of age.

All Medicare Advantage Plans include:

• Medicare Part A (hospital insurance) coverage
• Medicare Part B (medical insurance) coverage
• Limits on the out-of-pocket costs you pay
• Emergency and urgent care*
• Hospice care (covered by Original Medicare)*

*Plans can charge different copays, coinsurance, and deductibles for these services

Most Medicare Advantage Plans also include:

• Medicare prescription drug coverage (Part D)
• Provider networks to help manage costs
• Extra coverage, such as vision, hearing, dental, and health and wellness programs

Depending on what’s offered in your area, you may have these options:

• HMO – Health Maintenance Organization: In most HMOs, you can only go to doctors, specialists, or hospitals on the plan’s list except in an emergency. You may also be required to get a referral from your primary care doctor prior to visiting a specialist.
• HMO-POS – HMO Point of Service Plan: This is an HMO Plan that allows you to get some services out-of-network for a higher cost.
• PPO – Preferred Provider Organization: In most PPOs, you pay less if you use doctors, hospitals, and other health care providers that belong to the Medicare Advantage plan’s network. You can use doctors, hospitals, and providers outside of the network, but you may pay higher copays and coinsurance.
• PFFS – Private Fee for Service: PFFS plans are like Original Medicare in that you can generally go to any doctor, other health care provider, or hospital if they agree to treat you. The Medicare Advantage Plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
• SNP – Special Needs Plan: SNPs provide focused and specialized health care for specific groups of people, such as those who have both Medicare and Medicaid, who live in a nursing home, or have certain chronic medical conditions.
• MSA – Medical Savings Account: 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.

Important Things to Remember

You Must Continue to Pay Your Part B Premium

If you enroll in a Medicare Advantage plan you will need to continue paying your Medicare Part B premium, as well as any premium charged by the plan you choose. A monthly premium may apply and can vary based on the plan selected.

You Can’t Have a Medicare Supplement Insurance Plan and a Medicare Advantage Plan at the Same Time

Medicare Advantage Plans are health insurance plans approved by Medicare and offered by private companies. Medicare Advantage Plans are different from Medicare Supplement Insurance Plans. If you enroll in a Medicare Advantage Plan, you cannot purchase a Medicare Supplement Insurance Plan.