Medicare Advantage Plans Guide
Medicare Advantage (MA) Plans, also referred to as Part C, are a way to get health coverage in the private insurance market. These plans are approved by the government and combine the benefits of Part A and Part B. Advantage Plans may come with added coverage like the SilverSneakers® and The Silver&Fit® fitness programs.
Here you will find general information about Part C. Because you must purchase MA plans from private insurance companies, each one is a bit different. Check with the insurance company to make sure it covers the benefits that you need before you enroll in a plan. Plans can change on a yearly basis, so always review yours annually.
Benefits of Medicare Advantage Plans
The primary benefit of these plans is that many give you additional coverage beyond what Part A and B covers. Here are some of the additional benefits that may come with choosing a Part C plan:
- Prescription Drug Coverage: You may be able to add Part D prescription drug coverage.
- Extra Coverage: Some plans offer added coverage like dental, vision, hearing, and health and wellness programs.
- Low or No Deductibles: Many have a zero deductible or a lower deductible than Original Medicare.
- Zero or Low Premiums: You might pay a very little or even zero premium for this type of plan. In 2016, the average premium was $37 per month. (Note: This premium is in addition to the Part B premium, which is automatically deducted from Social Security benefits.)
Not all policies offer the same added coverage, so choose a plan that meets your needs. For 2017 details, read about potential plan changes.
The Different Types of Plans
Part C works similarly to health insurance offered by employers. Private insurance companies approved by the Centers for Medicare & Medicaid Services (CMS) compete to offer coverage to beneficiaries. Some plans have little or no cost to the consumer, but others require that you use only “in-network” doctors, specialists, and facilities to receive coverage.
Although each plan is different, all of these plans are required to include everything Part A and Part B cover. If you also require Part D, you generally must choose an Advantage Plan that includes drug coverage as part of its benefits. If you join a Medical Savings Account or Private Fee-for-Service (PFFS) Plan (without drug coverage), you are still eligible to sign up for stand-alone Part D plan.
HMO (Health Maintenance Organization) Plan
HMO Plans require you to choose a primary care doctor and only visit specific doctors, specialists, or hospitals within the plan’s network. Exceptions to this rule include emergency care, out-of-area urgent care, and out-of-area dialysis. To see a specialist in HMO Plans, you usually have to talk to your primary care physician for a referral. Read more about getting care with HMO insurance.
PPO (Preferred Provider Organization)
PPO Plans offer a network of doctors and hospitals to choose from; however, you may choose to use a doctor outside of the network at a higher out-of-pocket cost. PPOs also do not require you to select a primary care doctor and do not require referrals when visiting specialists. Learn more about PPO insurance.
A PFFS Plan allows you to visit any Medicare-approved doctor or facility that agrees to treat you and accepts the plan’s payment for services. Some PFFS Plans have a network of providers who will always treat you, even if you’ve never visited before. But out-of-network providers may choose not to treat you, even if you visited them before.
SNPs (special needs plans)
SNPs are for people with certain conditions or living circumstances. These plans are tailored to provide the proper benefits, provider choices, and drug formularies to best meet the needs of the individuals they serve. SNPs always include prescription drug coverage. For more information, read the guide to SNP eligibility.
Prescription Drug Coverage
If you need prescription drug coverage, be sure to choose a Part D plan that includes coverage for your medications. You cannot add a stand-alone Prescription Drug Plan or enroll in Supplement Insurance (“Medigap”) if you enroll in Part C. We have more details on our Part D prescription drug coverage page.
To enroll in an MA Plan, you must meet all of the criteria below:
- You must be 65 years old or disabled and under age 65.
- You are a US Citizen (or have been a permanent legal resident for 5 years.)
- You live in the area of the state that qualifies for your plan’s coverage.
- You already have Part A and Part B.
- You don’t have end-stage renal disease (ESRD).
Need more information? Read more about the rules for joining Advantage.
How to Enroll
These are your opportunities to enroll in or change your plan:
- Sign up during the Initial Coverage Election Period, which is usually the same period as your Initial Enrollment Period.
- If you already have an Advantage Plan, you can switch to a new plan during the Annual Enrollment Period. This period lasts from October 15 to December 7 each year.
- You can drop and switch to Part A and B during the Advantage Disenrollment Period, which lasts from January 1 to February 14 each year.
Each plan is a little different, so it’s important to review the plans available in your area to see which might work for you. All you need to get started is your Medicare number and the date that your coverage started.
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