A Medicare Advantage plan (or Medicare Part C), is a healthcare plan operated by an insurance company that implements your Medicare Part A (in-patient and hospitalization), Medicare Part B (out-patient and doctor care), and possibly your Medicare Part D (prescription drug) coverage - and may include additional hearing, vision, dental, and fitness coverage.
Medicare Advantage plans must provide Medicare Part A and Medicare Part B coverage at least as good as your Original Medicare Part A and Medicare Part B.
A Medicare Advantage plan with drug coverage is called an MAPD. A Medicare Advantage plan without drug coverage is called an MA
If you join a Medicare Advantage MA plan, you may not be allowed
to also join a separate Medicare Part D plan. Monthly premiums for Medicare Advantage plan may actually be less than $0 (they pay you
a dividend or rebate on your Medicare Part B premium) or $0 or range to $150+ per month. Medicare Advantage plans are not the same as
A Medicare Advantage plan, according to the Centers for Medicare and Medicaid (CMS)
is defined as:
Health plan options that are approved by Medicare but run by private insurance companies. Medicare Advantage plans are part of the Medicare program.
With Medicare Advantage plans:
- You generally get all your Medicare-covered health care through that plan.
- Medicare Advantage plan coverage can include prescription drug coverage (with a MAPD).
- You may get extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs.
- You may have lower out-of-pocket costs than the Original Medicare plan.
- You may have to use the plan’s doctors and hospitals to get services.
- You don’t need to buy a Medigap policy (do not cancel your Medical Supplement until after you are enrolled in a Medicare Advantage Plan).
As noted, a Medicare Advantage plan must cover all medically necessary services found under Original Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
However, a Medicare Advantage plan can have a different cost-sharing system as compared to Original Medicare. You may be charged different co-payments (for example, $10 to $30 for a primary care doctor visit for Medicare-covered benefits) or co-insurance (30% Out-of-Network cost for durable medical equipment) or deductibles.
Medicare Advantage Plans are offered in different forms, such as:
- Health Maintenance Organization (HMO)
- Health Maintenance Organization with a Point of Service Option (HMO POS)
- Preferred Provider Organization (PPO)
- Private Fee-For-Service (PFFS)
- Medicare Special Needs Plans (SNPs)
- Medicare Medical Savings Account (MSAs)
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(source: Medicare.gov and Q1Medicare.com Online Team)