Medicare Advantage (Part C) plans are offered through private companies. As an alternative to original Medicare, plans include hospital and medical coverage and may offer additional benefits.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Advantage (Part C) plans are health plans offered by private companies that contract with Medicare to provide Medicare Part A and Part B benefits. Many plans also offer prescription drug coverage.
A person can enroll in or switch to an Advantage plan if they have original Medicare, and if the plan they want is offered in their area. A person enrolled in an Advantage plan may need to pay the plan premium, plus copays and deductibles.
Advantage Plans include:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plans (SNPs)
There are also HMO Point of Service (HMO-POS) and Medicare Medical Savings Account (MSA) plans, although they are less common types of plans.
If a plan stops participating in Medicare, the person enrolled in the plan can choose to go back to original Medicare, or join another Advantage plan.
As an alternative to original Medicare, Advantage plans provide the same coverage as Medicare plans A and B, including emergency and urgent care.
Many plans offer additional coverage for eye care, dental care, prescription drug coverage, aids for hearing, fitness membership, and wellness services.
If a person is not sure whether a service will be covered, they should check with their Medicare Advantage provider before enrolling.
Advantage premiums vary among plans, and some plans may not charge premiums. According to the Kaiser Family Foundation (KFF), average Advantage premiums in 2019 were $29 a month.
A person may also have to pay copays and deductibles, which also vary among plans. For example, some plans may charge a copay, such as $10 or $20 for each doctor visit.
Out-of-pocket costs may be lower than with original Medicare and have a yearly limit. That limit, which varies among plans, means that after a person has reached that amount, they will not pay anything for covered services.
This online tool can help a person find a plan and compare costs.
A person has several ways to find out more about Advantage plans.
- Call 1-800-MEDICARE to find out which plans are available in their area.
- Ask for a paper enrollment form from the plan, and return the completed plan to the company.
- Check this list about things to remember about Advantage plans.
- Use the Medicare Plan Finder tool to find a plan that suits their needs.
A person with end stage renal disease (ESRD) may enroll in an Advantage plan only if it is an SNP that accepts people with the condition.
There are 3 set time periods when a person can join a Medicare Advantage plan, or change or drop their current plan.
A person can join a Medicare Advantage plan when they first get Medicare. The Initial Enrollment Period centers on the day a person turns 65 years of age.
- It begins 3 months before the month a person turns 65.
- It includes the month a person turns 65.
- It ends 3 months after the month a person turns 65.
Each year from January to March, a person can sign up for original Medicare if they did not do so during the 7 months when they were initially eligible.
A person can then enroll in an Advantage plan from April to June, and their coverage would start in July.
During this enrollment period from October 15 to December 7, a person can switch Advantage plans, or choose to drop the plan. They can also make changes to a prescription plan (Part D).
A Medicare Advantage (Part C) plan is offered by private companies. It is an alternative to original Medicare Part A and Part B, and may offer additional benefits.
In addition to plan premiums, a person will have to cover copays and deductibles. Costs may vary among plans.
A person can join or change Advantage plans during various enrollment periods.