Medicare Advantage


Medicare Advantage Plans, also often referred to as “Part C” or “MA Plans” are a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all Part A and Part B benefits. You must be enrolled in Parts A and B while continuing to pay your Part B premium. Many also include your Part D (prescription drug benefits) as well. When you sign up for this type of plan, you do not use your government Medicare card when availing yourself of services; instead, the carrier sends you a card to use instead. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare.

How do Medicare Advantage Plans work?

These plans are offered by private companies approved to contract with Medicare. Joining a Medicare Advantage Plan means that you still have Medicare, but that your Part A (Hospital Insurance) and your Part B (Health Insurance) are billed and paid through the Medicare Advantage Plan you have chosen, as opposed to Original Medicare.

Medicare Advantage Plans Must Follow Medicare Rules

Medicare pays a fixed amount for your care each month to the carrier that supplies your Medicare Advantage Plan, and these carriers are all subject to the rules and regulations set by Medicare. This does not mean that all Medicare Advantage Plans provide the same benefits. Each plan can charge different out-of-pocket costs to you, and may have different rules for how you can get services. This can affect things like you needing a referral for a specialist, or being limited to using certain doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care. These rules are subject to change each year.

Drug coverage in Medicare Advantage Plans

You usually get prescription drug coverage through your Medicare Advantage Plan. There are, however, some types of Medicare Advantage Plans that do not offer drug coverage, or offer prescription coverage for an additional premium. If there is no drug coverage associated with the Medicare Advantage Plan of your choice, you will have to enroll in a separate Medicare Prescription Drug Plan.

It is important to know that you cannot have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Part D Plan at the same time. If you're in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you'll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.