Medicare Advantage Plans (Part C)

5 things to know about Medicare Advantage plans:

  1. It is also known as Medicare Part C.
  2. It is an alternative way to get Medicare coverage through private insurance companies instead of the federal government.
  3. It provides the same benefits as Original Medicare and may include additional benefits such as dental, vision, drug, and wellness program coverage.
  4. You must be enrolled in Original Medicare before you can enroll in a Medicare Advantage plan.
  5. Unlike Original Medicare, Medicare Advantage plans often have network restrictions.

Medicare Advantage plans (Medicare Part C) are a form of private health insurance that provide the same coverage as Medicare Parts A & B (Original Medicare) and may include additional benefits such as dental, vision, and prescription drug coverage.

Medicare Advantage plans are widely used in the United States. In 2014, approximately 15.7 million people were enrolled in Medicare Advantage plans, according to the Kaiser Family Foundation (KFF).

You enroll in a Medicare Advantage plan through a private insurance company, not the government.

You must be enrolled in Original Medicare before you can enroll in a Medicare Advantage plan.

Eligibility

There are 3 general eligibility requirements to qualify for Medicare Part C:

  1. You must be enrolled in Original Medicare (Parts A & B);
  2. There must be a Medicare Advantage plan offered in your area; and
  3. You do not have End Stage Renal Disease (ESRD).

You cannot have a Medicare Advantage plan and a Medicare Supplement insurance policy at the same time.

More info: Medicare Advantage eligibility

Benefits

All Medicare Advantage plans include the same standard benefits as Original Medicare. Some Medicare Advantage plans also provide extra benefits such as prescription drug, dental, and vision coverage. Additional benefits vary from plan to plan.

Some types of plans restrict your coverage to in-network health care providers.

More info: What does Medicare Part C cover?

Enrolling in a plan

Medicare requires that you enroll in, disenroll from, or make changes to your Medicare Advantage plan only during pre-determined enrollment periods.

If you are enrolling for the first time, you may be able to join a plan during your Initial Enrollment Period, which occurs around your 65th birthday.

You also may be able to join or switch plans during the annual Medicare Open Enrollment Period, which runs from October to December every year.

There are also Special Enrollment Periods that may let you join a plan outside of the main enrollment periods, depending on your circumstances.

More info: How to apply for a Medicare Advantage plan

Costs

If you enroll in a Medicare Advantage plan, you may have to pay some or all of the following expenses:

  1. Original Medicare premiums
  2. Medicare Advantage plan premiums
  3. Out-of-pocket costs such as co-payments, co-insurance, and deductibles

Plan options

In 2014, there were over 2,000 different Medicare Advantage plans available nationwide, according to the KFF. The number of plans available to you will depend in part on where you live and how many companies offer coverage in your area.

There are 5 major types of Medicare Advantage plans:

  1. Health Maintenance Organizations (HMOs)
  2. Preferred Provider Organizations (PPOs)
  3. Private Fee-for-Service (PFFS) plans
  4. Special Needs Plans (SNPs)
  5. Medical Savings Accounts (MSAs)

The type of plan you choose may affect your prescription drug coverage options, referral requirements, and network restrictions.

More info: Medicare Advantage plan options

Comparing Medicare Advantage plans

You should review the following 4 factors before enrolling in a specific Medicare Advantage plan:

  1. Type of plan
  2. Benefits
  3. Star rating
  4. Costs

More info: Comparing Medicare Advantage plans