Medicare Advantage Plans

Medicare Part C – General Coverage Information

Medicare Part C, also known as Medicare Advantage, is a health care coverage option you can choose when you are eligible for Medicare Part A and Part B. Medicare Advantage is a type of health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. As with Original Medicare, enrollees in an MA plan can join a plan even if you have a pre-existing condition (except for ESRD). You will still have the same rights and protections as you would under Original Medicare, including the right to appeal decisions made regarding your care.

There are several types of MA plans to choose from, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) Plans, Special Needs Plans (SNPs), HMO Point of Service Plans, and Medicare Medical Savings Account (MSA) Plans. If you enroll in a Medicare Advantage Plan, your Medicare services and supplies will be covered through the plan and will not be paid for by Original Medicare. MA plans must offer the same benefits as Original Medicare, but many of them offer additional benefits, including, but not limited to, vision care, dental care, hearing exams and many offer prescription drug coverage (Part D).

Medicare pays a fixed amount to these companies that offer MA plans, and they must follow rules set by the federal government. These companies can vary in costs and services, though, so it is important to compare plans available in your area. Most MA plans require their members to use their network of physicians, hospitals, providers, and pharmacies. If you choose to go out of network, you may have to pay higher costs. If you choose a Medicare Advantage plan with prescription drug coverage (an MA-PD), you should consider that each plan my have a different formulary, or list of covered drugs, and may have different tiers, or levels, of pricing for the covered medications.

Frequently Asked Questions


Q: Do I need Part A and Part B to sign up for a Medicare Advantage plan?

A: Yes, Medicare Advantage will provide you with both Part A and Part B coverage.

Q: Do all Part C plans include drug coverage?

A: Although there are many Medicare Advantage plans that do include prescription drug coverage, not all of them do. The MA plans that do include prescription coverage may vary in their costs and formulary. Carefully compare and choose a plan based on your own personal needs.

Q: Do all Medicare Advantage plans cost the same?

A: No, Medicare Advantage plans can have varying premiums, deductibles, and copayments. Because some plans offer different benefits, comparing plans is the best way to find the one that meets your personal needs.

Q: If I have Original Medicare, but want to enroll in a Medicare Advantage plan, can I change my coverage?

A: Yes, Medicare beneficiaries have the opportunity to make changes in coverage during the Annual Election Period (AEP). If you are not satisfied with your current coverage, the AEP, which begins October 15 and ends December 7, is your chance to find coverage that is right for you. If you are switching from Original Medicare and have a stand-alone Prescription Drug Plan, you may want to consider enrolling in a Medicare Advantage plan with prescription drug coverage (MA-PD).

Q: What benefits are included in MA plans?

A: Medicare Advantage plans will include your Part A and Part B benefits, but many offer additional coverage, including, but not limited to, prescription drug coverage, vision care, hearing exams, dental care, and fitness programs. MA plans must offer at least the same benefits as Original Medicare, but the additional benefits they offer can vary. Comparing plans available is crucial so you find the plan that will be best for your healthcare coverage needs and your financial goals.

Q: Will I be turned down from a Medicare Advantage plan due to pre-existing conditions?

A: No, Medicare Advantage enrollment is not subject to medical underwriting, so you cannot be denied enrollment due to a pre-existing condition, unless you have ESRD (end-stage renal disease). Beneficiaries with ESRD usually receive their Medicare coverage through Original Medicare, unless there is a Special Needs Plan for individuals with ESRD available in your area.

Q: I’ve only heard of HMOs and PPOs. Are those the only Medicare Advantage plans that exist?

A: Even though the HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) are the most popular types of Medicare Advantage plans, there are others, including Private Fee For Service (PFFS) Plans, Special Needs Plans (SNPs), HMO Point of Service Plans, and Medical Savings Accounts (MSA).

Q: What is a Special Needs Plan?

A: A Special Needs Plan (SNP) is a Medicare Advantage plan that limits enrollment to only those individuals with specific diseases or characteristics. The benefits, provider choices, and drug formularies (list of covered drugs) are designed to best meet the specific needs of the groups they serve. You can join a Medicare SNP if you have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), live in the plan’s service area, and meet the plan’s eligibility requirements.

Q: Do Medicare Advantage plans offer preventive services?

A: Medicare Advantage plans include Part A and Part B benefits, and must offer at least the same benefits, including preventive services, as Original Medicare. Part B includes many preventive services, including but not limited to: flu shots, cancer screenings, bone mass measurements, glaucoma tests, and yearly wellness visits. Many MA plans offer additional benefits as well.

Q: If I join a Medicare Advantage plan now, will the plan be able to raise their premiums in a few months?

A: Medicare Advantage plans establish the amounts you will pay for premiums, deductibles, and copayments once a year – January 1. They cannot change your costs during the year.