Medicare Advantage basics
Part C offers an alternate way to receive your Medicare benefits
(see below for more information). While the majority of people
with Medicare get their health coverage from Original Medicare,
some choose to get their benefits from a Medicare Advantage Plan,
also known as a Medicare private health plan or Part C. MA Plans
contract with the federal government and are paid a fixed amount
per person to provide Medicare benefits.
The most common types of MA Plan are:
The most common types of Medicare Advantage Plan
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Private Fee-For-Service (PFFS)
You may also see
- Special Needs Plans (SNPs)
- Provider Sponsored Organizations (PSOs)
- Medical Savings Accounts (MSAs)
Remember, you still have Medicare if you enroll in an MA Plan.
This means that you likely pay a monthly premium for Part B
(and a Part A premium, if you have one). If you are enrolled
in an MA Plan, you should receive the same benefits offered by
Original Medicare. Keep in mind that your MA Plan may apply
different rules, costs, and restrictions, which can affect how
and when you receive care. They may also offer certain
benefits that Medicare does not cover, such as dental and
vision care, caregiver counseling and training, and certain
in-home support like housekeeping. Not all MA Plans cover
additional benefits, so check with a plan directly to learn
what benefits it covers.
All Medicare Advantage Plans must include a limit on your
out-of-pocket expenses for Part A and B services. For example,
the maximum out-of-pocket cost for HMO plans in 2021 is
$7,550. These limits tend to be high. In addition, while plans
cannot charge higher copayments or coinsurances than Original
Medicare for certain services, like chemotherapy and dialysis,
they can charge higher cost-sharing for other services.
Remember: Medicare Advantage Plans may have different
- Networks of providers
- Coverage rules
- Premiums (in addition to the Part B premium)
- Cost-sharing for covered services
Even plans of the same type offered by different companies may
have different rules, so you should always check with a plan
directly to find out how its coverage works.
You can join an MA Plan if
- You have Medicare Parts A and B
- And, you live in the plan’s service area
Many Medicare Advantage Plans also offer prescription drug
coverage (Part D). If you join an MSA plan or a PFFS plan
without drug coverage, you can enroll in a stand-alone Part D
plan. Remember that people with Original Medicare who want
Part D coverage also enroll in a stand-alone Part D plan.
If you have health coverage from your union or employer
(current or former) when you become eligible for Medicare, you
may automatically be enrolled in an MA Plan that they sponsor.
You have the choice to stay with this plan, switch to Original
Medicare, or enroll in a different MA Plan. Be aware that if
you switch to Original Medicare or enroll in a different MA
Plan, your employer or union could terminate or reduce your
health benefits, the health benefits of your dependents, and
any other benefits you get from your company. Talk to your
employer/union and your plan before making changes to find out
how your health benefits and other benefits may be affected.