What is Medicare Advantage

We've put this section together to help answer some of your questions, but feel free to contact us with your questions.

Medicare Advantage Plans (also known as Medicare Part C) are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include Medicare Part D prescription drug coverage or you can enroll in a separate Medicare Part D prescription drug coverage plan. Medicare Advantage Plans include:

  • Health Maintenance Organizations (HMO)
  • Preferred Provider Organizations (PPO)
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNP)
  • Medical Savings Accounts (MSA)

No health questions are asked (except the existence of End Stage Renal Disease or to qualify for certain Special Needs Plans). Acceptance is guaranteed for all Medicare eligibles every year during the appropriate enrollment period regardless of health conditions (except End Stage Renal Disease). Dual Eligibles -- people on both Medicare and Medicaid -- can enroll year-round. Most Medicare Advantage plans require you to pay a co-pay each time you see a doctor, receive medical treatment, or visit a hospital. The maximum out-of-pocket expenses you are required to pay are often capped on a per-year basis, but not always.

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most cases there are extra benefits and lower co-payments than in the Original Medicare Plan. However, with PPO and HMO plans you may have to see doctors that belong to the plan or go to certain hospitals to get services or risk higher out-of-pocket expenses for going "out-of-network". PPFS plans enable you to see any health care provider that accepts Medicare assignment as well as the terms and conditions of the PFFS Plan.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. Depending on where you live, some Medicare Advantage Plans have a $0 premium plan option, and some even reimburse you for part of your Medicare Part B premium. Some plans include dental and vision benefits in addition to coverage for hospital stays, doctor visits, diagnostic tests, inpatient and outpatient services, skilled nursing, and more. Some plans even include free health club memberships.

If you join a Medicare Advantage Plan, your Medigap (also known as a Medicare Supplement) policy won't work. This means it won't pay any deductibles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to drop your Medigap policy if you join a Medicare Advantage Plan. However, you have a legal right to keep the Medigap policy.

from Medicare.gov, Medicare Advantage Plans (2012)