Medicare Advantage Plans, sometimes called Part C or MA Plans, are an alternative way to receive your Medicare benefits. These plans are offered by private companies approved by Medicare and provide all Part A (Hospital Insurance) and Part B (Medical Insurance) coverage, and typically Part D (prescription drug) as well.
Types of Medicare Advantage Plans
- HMO (Health Maintenance Organization) - Requires members to use healthcare providers in the plan’s network and get a referral to see a specialist.
- PPO (Preferred Provider Organization) - Members can use doctors, hospitals, and providers outside of the network for an additional cost.
- Private Fee-for-Service Plans (PFFS) - Allows members to go to any Medicare-approved doctor or hospital that accepts the plan’s payment terms.
- Special Needs Plans (SNPs) - Designed for people with specific diseases or characteristics.
Additional Benefits
Many Medicare Advantage Plans offer additional benefits not covered by Original Medicare, such as:
- Vision care
- Hearing aids
- Dental care
- Wellness programs
These plans often include a Medicare Prescription Drug Plan (Part D) into their benefits structure. All members must also be enrolled in Medicare Parts A and B to be eligible for a Medicare Advantage Plan.
Costs and Payments
Medicare pays a fixed amount each month to the companies offering Medicare Advantage Plans. Costs for these plans include Part B premiums (and potentially additional plan premiums), co-payments, co-insurance, and deductibles. Enrollment, service areas, and the premiums can vary vastly between plans and regions.
For more information about enrollment and plan specifics, visit the Medicare.gov Guide to Medicare Advantage Plans.
Information on laws governing Medicare Advantage Plans is available through governmental resources such as the Centers for Medicare & Medicaid Services (CMS) or recent legislative texts such as the 21st Century Cures Act.
