A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You will get your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from the Part C Plan and not Original Medicare. In all types of Medicare Advantage Plans, you're always covered for emergency and urgent care. Part C Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you're in a Part C Plan.
Part C Plans aren't supplemental coverage—they're a completely separate coverage.
Part C Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Part C Plan.
Medicare pays a fixed amount for your care every month to the companies offering Part C Plans. These companies must follow rules set by Medicare. However, each Part C Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care).These rules can change each year.
Some other points to keep in mind about Part C Plans:
- You can join a Medicare Advantage Plan even if you have a pre-existing condition, except for End-Stage Renal Disease (ESRD).
- You can only join or leave a plan at certain times during the year.
- Each year, Medicare Advantage Plans can choose to leave Medicare or make changes to the services they cover and what you pay. If the plan decides to stop participating in Medicare, you will have to join another Medicare health plan or return to Original Medicare.
- You don't need to buy (and can't be sold) a Medicare Supplement Insurance (Medigap) policy while you're in a Medicare Advantage Plan.
- Whether the plan charges a monthly premium.
- Whether the plan pays any of your monthly Part B premium.
- Whether the plan has a yearly deductible or any additional deductibles.
- How much you pay for each visit or service (copayments or coinsurance).
- The type of health care services you need and how often you get them.
- Whether you go to a doctor or supplier who accepts assignment (if you're in a Preferred Provider Organization, Private Fee-for-Service Plan, or Medical Savings Account Plan and you go out-of-network).
- Whether you follow the plan's rules, like using network providers.
- Whether you need extra benefits and if the plan charges for it.
- The plan's yearly limit on your out-of-pocket costs for all medical services.