Medicare Part C (Medicare Advantage)

Medicare Advantage is a type of Medicare Plan offered by a private company that provides a person with all Medicare Part A and Part B benefits, and often additional benefits as well. Also called Part C, Medicare Advantage Plans can be:

  • HMOs (health maintenance organizations)
  • PPOs (preferred provider organizations)
  • Private Fee-for-Service Plans
  • Medical Savings Account Plans (MSAs)
  • Medicare Special Needs Plans

If a person is enrolled in a Medicare Advantage Plan, all Original Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans also offer prescription drug coverage that must follow the same rules as Medicare Prescription Drug Plans (Part D).

Medicare Advantage Plans may also offer more benefits than Original Medicare, such as vision, hearing, dental, and/or health and wellness programs. These plans also may have lower out-of-pocket costs than Original Medicare. In some plans, like HMOs, you may only be able to see certain doctors or go to certain hospitals to get covered services. Medicare Advantage plans are available in many areas of the country.?All people pay a monthly premium for their Medicare Advantage Plan. This payment is in addition to the monthly premium paid for Part B?.

Who Can Enroll in a Medicare Advantage Plan?

You can generally join a Medicare Advantage Plan if you meet these conditions:

  • You have Part A and Part B.
  • You live in the service area of the plan. Contact the plans you're interested in to find out about the service area.
  • You don't have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

How Much do Medicare Advantage Plans Cost?

The out-of-pocket costs for a Medicare Advantage Plan vary widely, and depend on the following:

  • Whether the plan charges a monthly premium in addition to your Part B premium. Medicare Advantage Plans charge one combined premium for Part A and Part B health coverage, Medicare prescription drug coverage (Part D) (if offered), and extra coverage (if offered).
  • Whether the plan pays any of the monthly Part B premium.
  • Whether the plan has a yearly deductible or any additional deductibles.
  • How much you pay for each visit or service (copayments).
  • The type of health care services you need and how often you get them.
  • Whether you follow the plan's rules, like using network providers.
  • Whether you need extra coverage and what the plan charges for it.

A few Medicare Advantage plans may pay all or part of your Part B premium. (You still get all Part A and Part B-covered services). Your Medicare Advantage plan premium may also include all or part of the premium for Medicare prescription drug coverage (Part D).