Medicare Advantage Plans

Medicare Advantage Plans, also called Part C, are a type of Medicare insurance plan that provides you additional benefits while also providing all your Part A and Part B benefits. 

As a bonus, most Medicare Advantage Plans also offer prescription drug coverage. 

How do Medicare Advantage Plans work?

Medicare Advantage Plans cover all Medicare Part A and B services while providing additional benefits Original Medicare does not offer. 

Each plan will have an out-of-pocket maximum (another thing Medicare does not offer) and, depending on your location, may have these benefits: 

  • Adult day-care services
  • Dental
  • Fitness club memberships
  • Hearing
  • Over-the-counter medications
  • Prescription drug coverage
  • Services and supports for those with chronic conditions
  • Transportation to doctor visits
  • Vision
  • Wellness Programs

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Types of Medicare Advantage Plans

The most common Part C plans are:

  • Health Maintenance Organization (HMO) Plans – Generally, you must get your healthcare services in your plan’s network unless it is emergency care, out-of-area urgent care, or out-of-area dialysis. Most plans will require you to choose a primary care doctor and receive a referral to see a specialist.
  • Preferred Provider Organization (PPO) Plans – PPO Plans do have network doctors, other health care providers, and hospitals. However, you don’t have to stay in the network. You will pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You don’t need to choose a primary care doctor in PPO Plans or get a referral to see a specialist.
  • Medicare Savings Account (MSA) Plans – Medicare MSA Plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs. The plan will only begin to cover your expenses once you meet a high yearly deductible, which varies by plan. Then, the MSA Plan deposits money into your account. You can use this savings account to pay your health care costs before you meet the deductible.
  • Dual-Eligible Special Needs Plans (DSNPs) – DSNPs are a type of Medicare Advantage plan that provides health benefits for people who are “dual eligible,” meaning they qualify for both Medicare and Medicaid. Usually, there will be no additional premium for these plans.

When to join a Medicare Advantage Plan

You can enroll in an Advantage when you first become eligible for Medicare and are enrolled in Parts A and B. 

Your initial enrollment period is a 7-month period that starts three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.

There are two other times each year after that you can join or make changes to a Part C plan.

The first is the annual election period from October 15 to December 7 in which you can: 

  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare drug plan to another Medicare drug plan.
  • Drop your Medicare prescription drug coverage completely.

The second is the Medicare Advantage Open Enrollment Period from January 1 to March 31 in which you can: 

  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Drop your Medicare Advantage Plan and return to Original Medicare. If you do this, you’ll also be able to join a Medicare Prescription Drug Plan.