Medicare Advantage Plans and Coverage

If you're eligible for Medicare, you may be looking into your coverage options and wondering what exactly a Medicare Advantage Plan is. Learn more here.

What is a Medicare Advantage Plan?

A Medicare Advantage Plan (also known as "Part C") is a type of health insurance plan that's offered by a private company and approved by Medicare. If you enroll in a Medicare Advantage Plan, the plan will provide all your Part A and Part B benefits.

What Do Medicare Advantage Plans Cover?

All Medicare Advantage Plans must cover the same basic benefits as Original Medicare (Part A and Part B). This means that your plan will cover hospital stays, doctor's visits, preventive services, prescription drugs, and more. Some plans may also offer additional coverage, like routine vision or dental care.

Who Is Eligible for a Medicare Advantage Plan?

You must be enrolled in both Part A and Part B of Original Medicare to be eligible for a Medicare Advantage Plan. You also cannot have End-Stage Renal Disease (ESRD).

The Difference Between Medicare Insurance and Medicare Advantage

It's important to understand the difference between Original Medicare (Part A and Part B) and a Medicare Advantage Plan. With Original Medicare, you have the freedom to see any doctor or specialist that accepts Medicare. However, you will likely have to pay out-of-pocket costs like deductibles, coinsurance, and copayments.

With a Medicare Advantage Plan, you will have an insurance company that manages your benefits and contracts with specific doctors and hospitals in your area. This means that you will likely have lower out-of-pocket costs than with Original Medicare, but you may have less flexibility in terms of which doctors you can see.

Before you enroll in any type of health insurance plan—whether it's Original Medicare or a private insurance company's plan—be sure to understand the coverage details so that you can make the best decision for your health care needs.

Top Rated Medicare Advantage Plan Providers

  1. Humana

  2. Blue Cross Blue Shield

  3. Aetna

  4. Wellcare

  5. eHealthcare

If you're enrolled in a Medicare Advantage Plan, you'll receive your Medicare benefits through a private insurance company that contracts with Medicare. Each Medicare Advantage Plan has its own rules about which health care providers you can see and how much you'll pay for services.

There are different types of Medicare Advantage Plans, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFSs), Special Needs Plans (SNPs), and HMO Point-of-Service Plans (HMOPOSs). The type of plan you have may affect which providers you can see.

You can usually choose your own primary care doctor from among the plan's network of providers. In some HMOs, you may need to get a referral from your primary care doctor in order to see a specialist.

It's important to make sure that the providers you want to see are included in the plan's network before enrolling. You can use Medicare's "Plan Finder" tool to compare the networks of different Medicare Advantage Plans in your area.

You can also contact the plans directly to ask about their networks. Once you're enrolled in a plan, you can usually switch to another plan once during each "open enrollment" period.

The costs of Medicare Advantage Plans vary depending on the type of plan and the insurer. Most plans offer extra benefits not covered by Original Medicare, such as prescription drug coverage, dental care, and vision care.

Some plans may also have lower deductibles and out-of-pocket costs than Original Medicare. You'll pay a monthly premium for most Medicare Advantage Plans, in addition to your Part B premium.

Before enrolling in a Medicare Advantage Plan, it's important to compare the costs and coverage of different plans to make sure you're getting the best value for your needs.

Medicare Advantage Plans Enrollment Now

Medicare Advantage Plans can be confusing to understand so it is best to make sure what is covered and what isn’t before service. Remember that if you're eligible for Medicare, you have the option to enroll in a private insurance company's plan in addition to (or instead of) Original Medicare. As always, be sure to do your research so that you can make the best decision for your health care needs.