Medicare Advantage Plans

There are different ways to get your Medicare coverage. Many are automatically enrolled in Original Medicare, Part A and Part B, when they turn 65. Original Medicare doesn’t include prescription drug coverage or routine dental care, but some Medicare Advantage plans may include these benefits, and more.

Unlike Medigap insurance, Medicare Advantage (Part C) plans don’t offer coverage to supplement Original Medicare. Instead, Medicare Part C plans are a private insurance alternative to the government program. With this option, you get all your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage through the insurance company instead of directly through the government. Medicare Advantage plans that include drug coverage can give you all your Medicare benefits in one policy; these are known as Medicare Advantage Prescription plans.

When you join a Medicare Advantage plan (Part C), you’re still in the Medicare program, and you’re still required to pay your monthly Medicare Part B premium; however, your Medicare services are covered and administered through a single policy.

There are four main types of Medicare Advantage plans: Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Private Fee-For-Service (PFFS) plans, and Special Needs Plans (SNPs).

What will a Medicare Advantage plan cost?

The costs of a Medicare Advantage plan can vary from one plan to another and one location to another. Here are some questions to consider when purchasing a Medicare Advantage plan:

  • Does the plan charge a monthly premium in addition to your Medicare Part B premium?
  • What is the plans annual deductible?
  • Is there a maximum out-of-pocket limit?
  • What type of health services do you need? How often?
  • Does this plan have network restrictions?
  • If the plan covers prescription drugs, are all your medications covered?
  • How much will you pay for each service or visit (copayments or coinsurance), both in-network and out-of-network?
  • Are there any additional benefits in the plan, such as routine vision or dental coverage? Do you need them? What do these benefits cost?