What is Medicare Advantage?
Medicare Advantage is also called Medicare Part C. It is an alternative to Original Medicare.
Medicare Advantage plans are offered by private insurance companies contracted by Medicare. Plans combine the benefits of Medicare Part A with the benefits of Medicare Part B. Most plans also include prescription drug coverage and extra benefits not offered by Original Medicare—all combined in a single plan.
You must be enrolled in both Part A and Part B to join a Medicare Advantage plan. You remain enrolled in Medicare Parts A and B, but you receive your benefits through the plan instead of through Original Medicare.
Keep reading for more information
Understanding Medicare Advantage Plans (Part C)
Learn how Medicare Advantage plans offer hospital and medical coverage along with additional benefits that you don't get with Original Medicare, for example, vision, hearing and prescription drug coverage.
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What’s covered by Medicare Advantage?
By law, Medicare Advantage plans must provide at least the same coverage that’s offered by Original Medicare Parts A and B. Beyond what’s required, plans may include a variety of benefits. In general, Medicare Advantage plans help pay for the following services.
You may have many Medicare Advantage plans to choose from, and each plan is different. It’s important to look carefully at the specific benefits offered by plans you are considering.
What’s not covered by Medicare Advantage?
Medicare Advantage plans do not help with the cost of:
- Hospice care. Original Medicare Part A pays for hospice care even when you get your benefits through a private Medicare Advantage plan. The Medicare Advantage plan would continue to cover health care services not related to the hospice care.
- All of the prescription drugs that might be covered under a standalone Medicare prescription drug plan.
What are the coverage limits with Medicare Advantage?
Each Medicare Advantage plan sets its own coverage terms and limits. It’s important to carefully review the terms and limits of any plans you are interested in.
What providers can you see with Medicare Advantage?
There are different types of Medicare Advantage plans. Each type has its own terms about what providers you can see.
Medicare Advantage coordinated care In Medicare Advantage (Part C), this refers to a kind of health care plan that links providers and services to deliver efficient, cost-effective patient care. Plan members usually have to use doctors and hospitals that are within the plan’s network. These plans are also referred to as “managed care plans.” plans require you to choose a primary care doctor to manage your care. Your doctor must refer you to other providers or specialists if you need special care. Coordinated care plans contract with health care providers to provide cost-effective, quality care to plan members. These providers make up the plan’s networkThe group of health care providers, such as hospitals, doctors and pharmacies, that agrees to provide care to the members of a Medicare Advantage coordinated care plan or Medicare Part D prescription drug plan. These providers are called “network providers” and “network pharmacies.”. The term “provider” refers to health professionals, pharmacies and medical facilities. Each plan has its own network.
With coordinated plans, you must get your care and services from network providers. Otherwise, the plan may not cover them.
Certain types of Medicare Advantage plans allow you to see any Medicare-eligible provider who accepts the terms, conditions and payment rates of the plan. These plans often require providers to give their acceptance each and every time before they deliver any care or services.
All Medicare Advantage plans provide nationwide coverage for emergency care, urgent care and renal dialysis.
What is a service area?
Each Medicare Advantage plan has a service area. This is a geographic area where the plan is available and offers coverage. A service area is usually a county, state or region. You must live in a plan’s service area in order to join it.