Medicare Advantage (MA) plans provide Medicare services and are administered by private health insurance plans.
Some MA plans include prescription drug coverage. If they do not cover, you would need to purchase a separate Medicare Part D plan.
Once enrolled in an MA plan, there are limited opportunities to switch back to Original Medicare + Medigap plan. Make sure you understand your choice before you enroll.
Medicare Advantage (MA) also referred to as Part C plans are private health plans that have contracts with Medicare. If you decide to enroll in an MA plan, your Medicare-covered healthcare services go through the private plan. Medicare Part C plans typically require the use of in-network providers that have contracts with the MA plan that consist of doctors, hospitals, drug stores and other healthcare providers. The use of providers outside the plan’s network can have additional costs or not be covered by Medicare.
What's included in an MA Plan?
- Medicare Part A (hospital services) and Part B (doctor’s visits)
- Vision, dental, hearing and transportation services (optional)
The costs under an MA plan are different from Original Medicare. MA plans may also cover prescription drugs. If prescription drugs are offered, purchasing a separate Medicare prescription drug plan is not allowed.
Enrollment in Medicare Parts A and B is a requirement to join an MA plan. Part B premiums must be paid along with any additional premium that the plan may charge. The Part B premium usually comes out of Social Security checks automatically, but you should confirm with the MA plans before deciding to enroll.
The different types of Medicare Advantage plans
There are 5 options for the type of MA plan available.
- Health Maintenance Organizations (HMOs) - If care is not received from an HMO approved provider, called an in-network provider, Medicare will not cover it. A referral is typically needed from a primary care provider to see a specialist.
- Medical Savings Accounts (MSAs) - A high deductible must be paid before the plan covers any benefits. A health savings account is linked to the plan and Medicare puts money in the savings account each year, but the amount is less than the annual deductible.
- Preferred Provider Organizations (PPOs) - Care from a Medicare provider out-of-network can be received, but the costs are higher. A primary care doctor is not needed.
- Private Fee-for-Service plans (PFFS) - There is no network of providers. Any Medicare provider who agrees to the plan’s terms and payments can be seen. Providers can decide on a case-by-case and visit-by-visit basis whether to see a Medicare beneficiary.
- Special Needs Plans (SNPs) - These are PPOs or HMOs that only admit people with Medicare who have certain conditions. Learn more .
Enrolling in both MA and Medigap (Supplemental insurance) is not allowed
If enrolled in a Medicare Advantage plan, purchasing a Medigap policy is not allowed. Once enrolled in an MA plan there are limited opportunities to switch to a Medigap policy + Original Medicare in the future. It is important to understand your choice before you enroll.