A Medicare Advantage Plan is another health coverage choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered and overstated by private companies approved by Medicare.

Medicare pays a fixed fee to the plan, and the insurance company's plan pays for the care. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan).

They can offer health benefits at a low monthly premium beyond the Medicare Part B premium. They offer coverage for hospitals, doctors, and prescription drug coverage. You may also receive additional benefits, such as vision, hearing health screening tests and preventative dental.

You may have a network of hospitals and doctors. In most plans, you need to use plan doctors, hospitals, and other providers, or you pay more or all of the costs. When you use the insurance, you will have to pay a co-pay or co-insurance to the facility or doctor for covered services. The benefits and premiums in Medicare Advantage plans can change on January 1st. For people who want an advantage plan, they need to enroll during an enrollment period or qualify for a special election period.

In all plan types, you are always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you are in a Medicare Advantage Plan. Medicare Advantage Plans aren't considered supplemental coverage.

If you join a Medicare Advantage Plan, you don't need a Medigap policy. If you already have a Medigap policy, you can't use it to pay for out-of-pocket costs you have under the Medicare Advantage Plan. If you already have a Medicare Advantage Plan, you can't be sold a Medigap policy.

Not all Medicare Advantage Plans work the same way, so before you join, find out the plan's rules, what your costs will be, and whether the plan will meet your needs.

Medicare Advantage plans vary by county and states. Also costs, extra coverage, and rules vary by plan.

Notes about The Medicare Advantage Program

- As with Original Medicare, you still have Medicare rights and protections, including the right to appeal.
- Check with the plan before you get a service to find out whether they will cover the service and what your costs may be.
- You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan.
- You can join a Medicare Advantage Plan even if you have a preexisting condition, except for End-Stage Renal Disease.
- You can only join a plan at certain times during the year. In most cases, you are enrolled in a plan for a year.
- If you go to a doctor, facility, or supplier that doesn't belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan.
- If the plan decides to stop participating in Medicare, you will have to join another Medicare health plan or return to Original Medicare.

 

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