medicare advantage

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What is Medicare Advantage or Medicare Part C?


‚ÄčA Medicare Advantage (MA) Plan is also known as Medicare Part C and is available to those Medicare beneficiaries enrolled in Medicare Parts A & B.  Medicare Advantage plans are offered by private companies that contract with Centers for Medicare & Medicaid Services (CMS) on an annual basis to provide you with all your Parts A & B benefits at a minimum.  Typically Medicare Advantage plans offer benefits that replace Original Medicare deductibles, copays, and coinsurances with lower out-of-pocket costs, but there are a number of factors to consider before selecting a plan such as:  availability, network, prescription drugs, and premiums to name a few.

Medicare Advantage Plans include Health Maintenance Organizations (HMO), Health Maintenance Organization-Point of Service (HMOPOS), Preferred Provider Organization (PPO), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNP), and Medicare Medical Savings Account (MSA) Plans. If you're enrolled in a Medicare Advantage Plan, services are covered and paid through the plan's private company, not Original Medicare. Enrolling in a Medicare Advantage Plan does not mean you have disenrolled, lost, given up, or are no longer eligible for Original Medicare.

Medicare Advantage plans may also include Prescription Drug Coverage (Part D) and are referred to as Medicare Advantage Prescription Drug (MAPD) Plans.  Some Medicare Advantage plans are required (in most instances) to include Part D coverage such as HMOs and PPOs, where as it is optional for PFFS plans.

Every year Medicare Advantage plans, whether an MA or MAPD, may be modified, canceled, or remain the same, as well as new plans may be introduced.  Besides at the point of one's initial enrollment into Medicare Part B, all Medicare beneficiaries regardless of their current plan have the opportunity to enroll or make changes to their Medicare Advantage and/or Prescription Drug plan during the Annual Election Period (AEP) which begins October 15 and ends December 7 of each year.  There are also other election periods in which one can change Medicare Advantage and/or Prescription Drug plans, but these are not available to all Medicare beneficiaries like during AEP and the time frames and requirements to make such changes will depend on the individuals situation.