How do Medicare Advantage Plans work?
What is a Medicare Advantage Plan?
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations(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 (MA or MAPD), Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans (MAPD's) offer prescription drug coverage.
Medicare Advantage Plans, sometimes called "Part C" or "MA Plans or MAPD Plans," are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and NOT Original Medicare.
Medicare Advantage Plans cover all Medicare services
Medicare health plans provide Part A and Part B benefits to people with Medicare who enroll in these plans, which include Medicare Advantage Plans, Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE).
Medicare Advantage Plans must follow Medicare's rules
Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.
Costs for Medicare health plans
Find out what factors contribute to how much you pay out-of-pocket when you have a Medicare health plan.
Drug coverage in Medicare Advantage Plans
You usually get prescription drug coverage through the plan. In some types of plans that don't offer drug coverage, you can join a Medicare Prescription Drug Plan.
You can't have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. If you're in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you'll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.