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Advantage Plans

Medicare Advantage (Part C) Plans in Washington

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 Medicare Advantage Plan and not Original Medicare.

There are four common types of Medicare Advantage Plans:

  1. Health Maintenance Organization (HMO) Plans—In most HMOs, you can only go to doctors, other health care providers, or hospitals on the plan’s list except in an emergency. You may also need to get a referral from your primary care doctor.
  2. Preferred Provider Organization (PPO) Plans—In a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You pay more if you use doctors, hospitals, and providers outside of the network.
  3. Private Fee-for-Service (PFFS) Plans—PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they agree to treat you. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
  4. Special Needs Plans (SNP)—SNPs provide focused and specialized health care for specific groups of people, such as those who have both Medicare and Medicaid, who live in a nursing home, or have certain chronic medical conditions.

And then there are several less-common types of Medicare Advantage Plans that may be available:

  • HMO Point-of-Service (HMOPOS) Plans—This is an HMO plan that may allow you to get some services out-of-network for a higher copayment or coinsurance.
  • Medical Savings Account (MSA) Plans—This is a plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.

In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage 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 Medicare Advantage Plan. Medicare Advantage Plans aren’t supplemental coverage.

Some additional points to remember about Part C plans:

  • Part C may require a monthly premium, as costs vary (most people pay between $0 and $200 per month).
  • You may have copays and other out-of-pocket costs.
  • Additionally, you must pay your Part B (doctor and outpatient care) premium.
  • Most Part C plans include prescription drug coverage (Part D).
  • Part C may provide additional coverage, such as vision and dental, not covered by Part A (hospital care) and Part B (doctor and outpatient care).

Here’s a list of Part C costs and costs by county in Washington state.

Many Part C plans require you to use regular services within the service area (except for emergency care), which is usually the county you live in.