What are Medicare Advantage health plans?
Medicare Advantage plans are private insurance health plans, regulated by the government. Medicare Advantage is also known as "MA" or Medicare Part C. All individuals enrolled in Original Medicare, Part A and Part B, are eligible to enroll in a Medicare Advantage plan, with the exception of those diagnosed with End Stage Renal Disease (ESRD), there are exceptions.
Medicare Advantage health plans offer the following coverage:
- Original Medicare coverage, the standardized hospitalization and medical benefits included in Part A and Part B, are required components of Medicare Advantage coverage. MA plans must deliver all benefits and services that Original Medicare covers, with the exception of hospice care; however, MA plans do not have to deliver these benefits in the same way.
- Additional benefits may be included in certain MA plans, which include:
- Prescription drug coverage
- Vision, dental, and/or hearing benefits
- Health and wellness programs (Silver Sneakers)
What are options for Medicare Advantage coverage?
Medicare Advantage plans deliver benefits through a number of different options:
- HMO - A health maintenance organization (HMO) is a network of health care providers and facilities, where you choose a primary care physician to coordinate your care.
- PPO - A preferred provider organization (PPO) is also a network of health care providers and facilities, but typically you do not need to select a primary care physician and have more flexibility regarding out-of-network care.
- PFFS - A private fee-for-service (PFFS) is a mode of benefit delivery where you are not limited to a network, but there are no guarantees that your doctor or hospital will accept the plan.
Other types of MA plans include HMO Point of Service (HMOPOS) plans and Medical Saving Account (MSA) plans. Eligible individuals must wait to enroll during an approved enrollment period.
Compare Medicare Advantage Plans
Medicare Advantage plans are available in every U.S. state, though the number of plans varies by state. Premiums for the same plan can even vary among counties within the same state. It is important to compare all available plan options in your area before enrolling in a MA plans. Here are a few factors to consider:
- What are the costs associated your coverage - Some Medicare Advantage plans offer premiums as low as $0. However, with recent legislation changing the compensation rate the plan is paid for MA services, these $0 premiums may become less widely available
- Whether the plan has drug coverage - Most, but not all, MA plans offer drug coverage; these plans are also known as Medicare Advantage Prescription Drug plans, or MAPDs. However, if you have existing creditable drug coverage, you may be interested in a plan without drug coverage.
- What additional benefits are offered - Medicare Advantage plans will sometimes offer benefits beyond what is covered in Original Medicare.
Eligible beneficiaries can compare available Medicare Advantage health plans in their area by using PlanPrescriber's free Medicare Advantage plan comparison tool. The tool allows you to customize your search based on your health and prescription drug needs.
Medicare has neither reviewed nor endorsed this information.