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What are Medicare Advantage Plans?

A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services. Some plans offer non-emergency coverage out of network, but typically at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.

If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.

What are the different types of Medicare Advantage Plans?

• Health Maintenance Organization (HMO) plan
• HMO Point-of-Service (HMOPOS) plan: This HMO plan may allow you to get some services out of network for a higher copayment or coinsurance. 
• Medical Savings Account (MSA) plans
• Preferred Provider Organization (PPO) plan
• Private Fee-for-Service (PFFS) plan
• Special Needs Plan (SNP)
  What do Medicare Advantage Plans cover?
  Medicare Advantage Plans provide all of your Part A and Part B benefits, excluding clinical trials, hospice services, and, for a temporary time, some new benefits that come from legislation or national coverage determinations. Plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers. If you’re in a Medicare Advantage Plan, Original Medicare will still help cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies.

To join a Medicare Advantage Plan you must:

• Have Part A and Part B.
• Live in the plan’s service area.
• Be a United States citizen or lawfully present in the United States.
  

Joining and leaving

• You can join a Medicare Advantage Plan even if you have a pre-existing condition.
• You can join or leave a Medicare Advantage Plan only at certain times during the year. See pages 71–72.
• Each year, Medicare Advantage Plans can choose to leave Medicare or make changes in coverage, costs, service area, and more. If the plan decides to stop participating in Medicare, you’ll have to join another Medicare Advantage Plan or return to Original Medicare. See page 98.
• Medicare Advantage Plans must follow certain rules when giving you information about how to join their plan. See page 106 for more information about these rules and how to protect your personal information.

What do Medicare Advantage Plans cover?
Medicare Advantage Plans provide all of your Part A and Part B benefits, excluding clinical trials, hospice services, and, for a temporary time, some new benefits that come from legislation or national coverage determinations. Plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers. If you’re in a Medicare Advantage Plan, Original Medicare will still help cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies.

Plans can offer some extra benefits

Most Medicare Advantage Plans offer coverage for things Original Medicare doesn’t cover, like fitness programs (like gym memberships or discounts) and some vision, hearing, and dental services. Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness. Plans can also tailor their benefit packages to offer additional benefits to certain chronically-ill enrollees. These packages will provide benefits customized to treat specific conditions. Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations.

(Source: 2022 Medicare and You Handbook Pages 61-63)