UPDATED May 8, 2019. Instead of staying with Original Medicare (Part A and Part B), you may decide to join in a Medicare Advantage Plans, also known as Part C plans. Medicare Advantage provides “all in one”alternative to Original Medicare bundling together Part A, Part B, and usually the Medicare Prescription Drug Plan (Part D).
Medicare Advantage plans are offered by private insurance companies approved by Medicare. Part C Plans are available in all fifty states. They are not Fee-for-Service plans, such as Original Medicare. Instead, Medicare pays a fixed amount every month to insurance companies for the enrolled members regardless of whether or not members used the services.
Medicare Advantage Plan Benefits
Medicare Advantage Plans cover all services that Original Medicare covers (Part A and Part B), except hospice care. Original Medicare covers hospice care even if you are in the Medicare Advantage plan.
Although Medicare Advantage plans are supposed to cover everything that Original Medicare covers, there is no obligation to include every benefit in the same way.
If you are enrolled in a Medicare Advantage plan, Medicare services are NOT paid for by Original Medicare.
Medicare Advantage plans are obliged to enroll anyone who is eligible. The same Part C benefits are offered to all members, regardless of age or health status. Consequently, pre-existing health conditions cannot be taken into account and enrollment cannot be denied, or the premium cannot be increased, because of health conditions.
There are multiple types of Medicare Advantage Plans available:
- Health Maintenance Organization plans (HMO)
- Prefer Provider Organization plans (PPO)
- Private Fee-for-Service plans (PFFS)
- Medical Savings Accounts plans (MSA)
- Special Needs plans (SNP)
For details, see Types of Medicare Advantage Plans: How are they Compared?
All Medicare Advantage Plans offer a maximum out-of-pocket yearly limit.
Extra Coverage Benefits
Part C plans benefits often include extra coverage, such as:
- Health and wellness programs
- Over-the-Counter Pharmacy Allowance (OTC)
Medicare Advantage plans can come as Medical only (MA) or may include Prescription Drug Coverage (MAPD).
Medicare Advantage vendors are now allowed to expand the scope of their coverage and provide several types of non-health related benefits. They include:
- In-home support services
- Home-based palliative care
- Transportation for non-emergency medical services
- Home safety devices and modifications
Rules for Medicare Advantage Services
Medicare Advantage plan can charge different out-of-pocket costs.
Medicare Advantage plans have different rules for how you can receive services. For example, whether you need a referral to see a specialist, or if you have to engage with doctors, facilities, or suppliers that belong to the plan. Medical emergencies are an exception because no referrals are necessary, and services are available anywhere in the U.S.
The rules can change each year.
You are still a part of the Medicare system. If your Medicare Advantage insurance company fails, you are guaranteed the acceptance back into Original Medicare.
Who is eligible for Medicare Advantage Plans?
You are eligible for Medicare Advantage plan if:
- You have both Medicare Part A and Part B
- You live in the service area of the plan
- You don’t have End-Stage Renal Disease (ESRD)
How Much does the Part C Plans Cost?
Each Part C plan typically charges a monthly premium in addition to the Part B premium (although, some plans actually pay the Part B premium). There are additional Medicare Advantage costs for Prescription Drug Coverage (if applicable), and for extra coverage (if applicable). The total cost may be higher or lower than you’ll pay under Original Medicare.
Each Part C plan can charge different out-of-pocket expenses. You usually pay copayments for each service. The plan may charge you a yearly deductible or any additional deductibles.
Medicare Advantage In Depth
Medicare Advantage Enrollment Periods
How to Compare Original Medicare with Medicare Advantage
How to Choose Medicare Advantage Plan – Questions to Ask
Medicare Advantage Plans for people with Medicare and Medicaid (Dual-eligible)
Frequently Asked Questions
- Do I lose Medicare if I join a Medicare Advantage Plan?
- NO, if you join a Medicare Advantage Plan, you still have Medicare.
- Does Medicare Advantage cover everything that Original Medicare cover?
- Am I limited in the choice of doctors and hospitals?
- Yes, you are limited with the plan’s network. If you have a PPO plan, you may visit doctors or hospitals outside of the network but with higher out-of-pocket expenses.
- Are Prescription Drug plans included in Medicare Advantage?
- Most Medicare Advantage plans include Prescription Drug Coverage (Part D). Some plans do not offer drug coverage (such as Medical Saving Account plans) or allow you a choice in drug plan selection (such as PFFS plans)
- When can I change the Medicare Advantage plan?
- Should I contact the old vendor to disenroll from my old plan?
- No, you’ll be disenrolled automatically from the old plan when your new coverage begins
- What will happen if I enroll in Stand-alone Prescription Drug plan having Medicare Advantage plan that includes Prescription Drug plan (MAPD)
- You’ll be disenrolled from MAPD plan
US Government Sources
- Medicare.gov – Medicare Advantage Plans
- How do Medicare Advantage Plans work?
- What’s a Medicare Advantage Plan?
Let Liberty Medicare Help you Choose
Liberty Medicare is here to help you every step of the way while you select and enroll in the best and most suitable Medicare Advantage Insurance Plan for you.
All of our services are entirely free to you. We’ll help you compare the key attributes of the Medicare Advantage Plans within your area including:
- Standard Benefits
- Associated Cost
- Doctor Access and Network Limitations
- Extra Benefits
- Prescription Drug Coverage
- Quality of Plan
Liberty Medicare represents many well-known Medicare Advantage providers in Delaware, Illinois, Maryland, New Jersey, New York, Ohio, Pennsylvania, and Virginia. Learn more about all the benefits of working with Liberty Medicare.
If you are looking for Medicare Advantage, please let us help. To see accurate quotes from Medicare Advantage providers, we invite you to fill out our Medicare Advantage Quote form. You also may give us a call at 877-657-7477, and you will be connected to a licensed agent/broker.