Medicare Advantage plans are also known as Medicare Part C. All Medicare Advantage plans are run by private insurance companies, and they all combine coverage for hospital stays with coverage for doctor visits, outpatient care and preventive care. Many also include extra benefits like vision and hearing exams. Most include prescription drug coverage, as well, often at no additional premium, or you can choose a plan without prescription drug coverage.

What providers can you see with Medicare Advantage?

The terms of these plans vary. In some plans, your health care is “coordinated”. That means the plan coordinates your coverage through a primary care physician who manages the care you receive from specialists and hospitals. You may have to choose specific doctors and hospitals.

In other plans, you can get care from any Medicare-eligible provider who accepts the terms, conditions and payment rates of the plan before providing coverage. Doctors and hospitals can decide whether or not to accept those terms, conditions and payment rates each time they furnish covered services.

Medicare Advantage service areas

All Medicare Advantage plans have “service areas.” These are areas, typically a county, state or region, where the plan offers coverage. You must live in a plan’s service area in order to join it. However, all Medicare Advantage plans must offer nationwide coverage for emergency care, urgent care (care provided outside a doctor’s office or emergency room for conditions that require immediate attention) and renal dialysis.

Medicare Advantage costs

Medicare Advantage premiums

If you join a Medicare Advantage plan, you will continue to pay your Medicare Part B premium and your Part A premium, if you have one. The plan may also charge its own premium, although some Medicare Advantage plans do not. Premiums for Medicare Advantage plans can vary widely.

Medicare Advantage cost sharing

Medicare Advantage deductible

Some plans charge an annual deductible, and some don’t. Review the plan costs for details.

Medicare Advantage copay

Many plans charge copays for the services and benefits you use. Review the plan costs for details.

Medicare Advantage coinsurance

Medicare Advantage plans set their own coinsurance terms and percentages. Some services may require coinsurance instead of a copay. Review the plan costs for details.

Maximum out-of-pocket limits with Medicare Advantage

All Medicare Advantage plans are required to protect you from high cost sharing by limiting the amount you may have to pay out-of-pocket for Part A and Part B services each year. In 2012, the limit is $6,700 for the year. Plans can set a lower limit, but no plan can ask you to pay more for these covered services. Keep in mind, there is no out-of-pocket maximum limit with Original Medicare (Part A and Part B).

Medicare Part D coverage gap

Many Medicare Advantage plans include prescription drug coverage under Medicare Part D. Learn about Medicare Part D cost sharing.