Medicare Advantage

Medicare Advantage Plans are health plans from private companies that contract with Medicare to deliver your Part A (Hospital) and Part B (Medical) benefits.

These plans come in different types, including:

• Health Maintenance Organizations (HMOs)

• Preferred Provider Organizations (PPOs)

• Private Fee-for-Service Plans (PFFS)

• Special Needs Plans (SNPs)

• Medicare Savings Account Plans (MSAs)

When you join a Medicare Advantage Plan, your care runs through the plan and not Original Medicare. Most Medicare Advantage Plans also include prescription drug coverage, giving you more complete benefits in one package.

How do Medicare Advantage Plans Work?

Medicare Advantage Plans, also known as “Part C” or “MA Plans,” come from private companies approved by Medicare. When you enroll in one, you still keep Medicare—but your Part A (Hospital Insurance) and Part B (Medical Insurance) benefits come directly through the plan instead of Original Medicare.

Medicare Advantage Plans cover all Medicare Services

Medicare health plans give people with Medicare their Part A and Part B benefits. These plans include Medicare Advantage Plans, Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-Inclusive Care for the Elderly (PACE).

Medicare Advantage Plans must follow Medicare’s Rules

Medicare pays private companies a fixed amount each month to provide Medicare Advantage Plans. These companies must follow Medicare’s rules, but each plan can set its own costs and guidelines.

Your out-of-pocket expenses and the way you access care may vary. For example, some plans require referrals to see specialists or limit you to certain doctors, facilities, or suppliers for non-emergency care. Plan rules can change every year, so it’s important to review your coverage annually.

Costs for Medicare health plans

Find out what factors contribute to how much you pay out-of-pocket when you have a Medicare health plan.

Drug Coverage in Medicare Advantage Plans

If you are already enrolled in a Medicare Advantage Plan that includes prescription drug coverage, it is important to be careful before making changes. For example, if you decide to enroll in a stand-alone Prescription Drug Plan (PDP), then Medicare will automatically disenroll you from your current Medicare Advantage Plan. As a result, your coverage will switch back to Original Medicare. Therefore, before adding a stand-alone drug plan, make sure to review your options so you don’t lose the benefits of your Advantage Plan by mistake.

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