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Medicare Advantage Plan (Part C)

April 04, 2011

By Katie Banks+

What is a Medicare Advantage Plan (Part C)?

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

If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Medicare pays a fixed amount for your care every month to the companies that offer Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs, and they can have different rules for how you obtain services (such as whether you need a referral to see a specialist). These rules can change each year.

Different Types of Medicare Advantage Plans

Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Special Needs Plans (SNP)

There are other less common types of Medicare Advantage Plans that may be available:

HMO Point of Service (HMOPOS) Plans— An HMO plan that may allow you to get some services out-of-network for a higher cost.
Medical Savings Account (MSA) Plans—A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.

How Much Does a Medicare Advantage Plan Cost?

In addition to your Part B premium, you usually pay one monthly premium for the services included. Each Medicare Advantage Plan can charge different out of-pocket costs. Your out-of-pocket costs in a Medicare Advantage Plan depend on:

Whether the plan charges a monthly premium.
Whether the plan pays any of your monthly Part B premium.
Whether the plan has a yearly deductible or any additional deductibles.
How much you pay for each visit or service (copayments or coinsurance).
The type of health care services you need and how often you get them.
Whether you follow the plan’s rules, like using network providers.
Whether you need extra benefits and if the plan charges for them.
The plan’s yearly limit on your out-of-pocket costs for all medical services.

What Does a Medicare Advantage Plan Cover?

In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers, with the exception of hospice care. Original Medicare covers hospice care, even if you’re in a Medicare Advantage Plan. Medicare Advantage Plans are not supplemental coverage; they may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

How Do I Get a Medicare Advantage Plan?

Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare health plans in your area. You can find quotes and compare plans easily using our Quoting Tool.

Comments for Medicare Advantage Plan (Part C)

By proness dan on September 19, 2011

I’m guessing that Some of private health insurers that offer Part C are ‘for profit’ enterprises” and some are non-profit organizations like Kaiser. Any thoughts on which is best??

By brian antony on September 22, 2011

Check with the Medicare plan before you get a service to find out whether they will cover the service and what your costs may be.

By kevin patrick on October 05, 2011

It says that “Medicare has a standard benefit package that covers medically necessary care that beneficiaries can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare private health plan, Medicare pays the private health plan a set amount every month for each member.” That’s how they make their money so some don’t have to charge additional amounts. I hear, however, that the private companies skimp and I will stay with Part A and B plus Medigap over Part C( MEdicare Advantage._)

By maryland botcher on October 05, 2011

If you can get a plan to cover Hospital Insurance and as well as Medical Insurance at no cost then that is really good plan. I doubt it though

By Campbell3424 on October 05, 2011

My medicare advantage plan is really good. And it cost me $0!!!

By jefferson lobo on October 07, 2011

I wanna Insured for particular thing,is that comes under SNP?? What does Special Needs Plans (SNP) means???

By jack marcia on October 08, 2011

Medical Advantage insurance policies are very expensive in my part of the woods. Coverage is of great importance in case of emergency but one should select the proper policy. Rght now I went with Part A and B but I will consider a Medigap plan if my budget allows. Is there a downside in waiting?

By rAY Ray on October 10, 2011

Ok. I think I get it. Either I go with Part A or B or I skip Part A and B and go with Part C. Part C is also called Medicare advantage. All the letters keep confusing me.

By Craig Stanback on October 11, 2011

I think i need to help clarify something for the commenters. (is that a word)? Having a medicare (part A and B) is the first thing to avoid any critical and financial problem during health emergencies. But you can purchase PArt C instead and get the same benefits. It’s just run by a private company. I don’t see anything wrong with that.

By Davies Diaz on October 12, 2011

Medicare plans has many advantages and it can help in costs during the crucial health time of a person. Everyone much have at least have part A and Part B. I’m not so sure i I need part C.

By lewis joe58 on October 12, 2011

Medicare Advantage is influenced by different local and regional factors that impacts the quality or quantity present in one location. Due to the aforementioned, I think you are better off with Medigap.

By chevychase25 on October 20, 2011

Medicare advantage plan is suitable for all kinds of people as their are many plans to meet their requirements. Sill i would go with a Part A, B and a Medigap plan. I just trust them more than the companies that run the Advantage plans.

By jeffersonlobo on November 10, 2011

Medicare plans take care of each and every applicant. I cannnot get covered with individual policy right now. I cannot wait until I’m 65. I just don’t know if I will go with PArt C or with Part A and B.

By Arianne Bass on November 25, 2011

Thats the point right here, Medicare pays for for some but not all of your health care costs. I wouldn`t have expected it to be some other way. Overall, I appreciate the government`s intention to invest in such a broad and valuable project. It might have cut funds in some other field, but at least they understand that basic health care is the most important service for the population. However, people still need to purchase a medicare advantage plan or a Medigap plan since Medicare alone only provides for basic care.

By Gail Boston MA on December 02, 2011

What might be the red flags in going with a medicare Advantage Program? In our area there is no cost , has a fitness benefit, can use any doctor( not an HMO),
also has a drug plan included. The co pays are low. Anything I should be aware of? Everything seems the same or better than as a Gap Plan except no monthly payments! Also, I understand that if it is your first time on an advantage program you can opt out any time and go back to a Gap Plan even mid year with no penalty.