Insurance education
Medicare Advantage (Part C) Explained
Medicare Advantage, also called Part C, is another way to receive your Medicare benefits. Instead of using Original Medicare directly, you get your Part A and Part B coverage through a private company that contracts with Medicare.
How Medicare Advantage Works
- Plans must cover the services Original Medicare covers, though their costs and rules differ.
- Most plans include Part D prescription drug coverage. These are often called MAPD plans.
- Some plans include extra benefits that Original Medicare does not cover, such as some dental, vision or hearing services. Benefits vary by plan.
- You generally still pay your Part B premium.
- Every plan has a yearly limit on what you pay out of pocket for covered Part A and Part B services.
Common Plan Types
- HMO (Health Maintenance Organization): you generally use doctors and hospitals in the plan's network and may need referrals to see specialists.
- PPO (Preferred Provider Organization): you pay less in network, and you can usually go out of network for a higher cost.
- Special Needs Plans (SNPs): designed for people with certain chronic conditions, people who live in an institution, or people with both Medicare and Medi-Cal.
Medicare Advantage vs. Medicare Supplement
| Topic | Original Medicare + Medigap | Medicare Advantage |
|---|---|---|
| Doctors and hospitals | Generally any provider in the U.S. that accepts Medicare | Usually a network, which varies by plan |
| Costs | Higher monthly premium, fewer costs when you use care | Often lower premium, with copays and coinsurance as you use care |
| Drug coverage | Added through a separate Part D plan | Usually included |
| Referrals | Generally not needed | Sometimes required, especially in HMOs |
| Travel | Coverage works across the U.S. | Routine care is usually limited to the plan's service area |
Neither approach is right for everyone. Your doctors, prescriptions, travel habits and budget all play a part. If you start with Medicare Advantage and later want a Medigap policy, you may have to answer health questions, so it is worth thinking about the long term.
When You Can Join or Change Plans
You can join a Medicare Advantage plan when you first become eligible, during the Annual Open Enrollment Period (October 15 to December 7), and during certain Special Enrollment Periods. If you are already in a Medicare Advantage plan, you can make one change between January 1 and March 31. See Medicare enrollment periods.
Questions to Ask About Any Plan
- Are my doctors and hospitals in the network?
- Are my prescriptions on the drug list, and at what tier?
- What is the yearly out-of-pocket limit?
- Do I need referrals to see specialists?
- How does the plan work when I travel?
Talk With Us About Your Situation
Reading about Medicare Advantage is a good start. Your own situation is what really matters. If you would like to talk through your options, call us at 310-440-0281 or toll free at (844) 532-9009, or contact us here. We will listen first, answer your questions and explain the choices available to you. There is no obligation to enroll in anything.