Medicare Advantage

Medicare Advantage (Part C) plans are approved by Medicare and are available from a private company, that offers an alternative to Original Medicare for your health and drug coverage.

• These “bundled” plans include Part A, Part B, and usually Part D.
• You must be enrolled in both Part A and Part B to join a Medicare Advantage Plan.
• You may pay a premium for the plan in addition to the monthly Part B premium.
• Plans may have a $0 premium or may help pay all or part of your Part B premiums.
• Plans must provide at least the same benefits as Original Medicare (aside from hospice care, which is still covered by Medicare Part A), but some Medicare Advantage plans offer additional benefits, such as prescription drug coverage and dental, vision and hearing coverage.
• Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and Part B covers. Once you reach your plan’s limit, you will not pay for services Part A and Part B covers for the rest of the year.
• Plans must cover all emergency and urgent care.
• Some plans tailor their benefit packages to offer additional benefits to treat specific chronic conditions and those that are enrolled in Medicare AND Medicaid.
• Each plan can have different rules for how you get services, like needing referrals to see a specialist. Some plans may require you to use doctors who are in the plan’s network.
• Plans may have lower out-of-pocket costs than Original Medicare.
• Plans generally don’t cover care outside the U.S. Some plans may offer a supplemental benefit that covers emergency and urgently needed services when traveling outside the U.S.
• You cannot buy or use separate supplemental coverage (like Medigap) when you are enrolled in a Medicare Advantage plan.
• Costs for monthly premiums and services you get vary depending on where you live, and which plan you join.

 

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