Medicare Advantage Plans

What are Medicare Advantage plans?

Medicare Advantage (also called Medicare Part C) offers a way to receive your Medicare benefits through a private, Medicare-approved insurance company instead of directly through the government.

Medicare Advantage plans must offer at least the same benefits as Original Medicare (Part A and Part B) except hospice care, which Medicare Part A still covers. But many Medicare Advantage plans offer additional benefits, such as routine vision, hearing, or dental care. Some Medicare Advantage plans may also provide prescription drug coverage, allowing you to get all your Medicare benefits in a single plan. However, you still need to continue paying your Medicare Part B premium.

There may be several types of Medicare Advantage plans for you to choose from, although not every plan option may be available in your area. Examples may include (but may not be limited to):

  • Health Maintenance Organization (HMO)s, which generally require beneficiaries to choose providers from the plan’s network. Specialty care typically requires a referral from a primary care provider.
  • Preferred Provider Organization (PPO) plans, which may allow beneficiaries to see any physician, but usually provide more coverage for physicians inside the plan’s network.
  • Private Fee-for-Service (PFFS) plans, which set their own rates in terms of what you pay for visits and how much providers are paid.

Prescription drug coverage and Medicare Advantage

Most Medicare Advantage plans also include prescription drug benefits. These plans are also referred to as Medicare Advantage Prescription Drug plans. These plans make it easy and convenient for beneficiaries to keep all their Medicare coverage under a single plan.

Medicare Advantage Prescription Drug plans each has a formulary; that is, a list of covered drugs. You might want to check the plan formularies when you’re shopping for a plan, to make sure prescriptions would be covered. Note that formularies can change, but you will receive notice from your plan when necessary.

Choosing a Medicare Advantage plan

Depending on where you, there may be several Medicare Advantage plans available. It may be a good idea to compare plans carefully before choosing one that suits your needs. Plans may vary in terms of the extra coverage offered. While some might include services like routine dental or vision care, others might not offer these benefits. Some may include prescription drug coverage, which might be helpful to a beneficiary taking prescription medications who do not want to keep track of more than one plan.

The cost of a Medicare Advantage plan might also vary, based on the company offering the plan, the amount of coverage included, and the plan’s location. Some companies may offer plan premiums as low as $0, but remember to take out-of-pocket costs, such as deductibles and copayments, into consideration; also remember you must still pay your monthly Part B premium.

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