What Is Medicare Advantage and How Does It Work?
Medicare Advantage plans, sometimes known as “Part C,” are a popular option for those ready to sign up for Medicare. What is Medicare Advantage? It’s coverage offered by private insurers working in conjunction with the Medicare program, providing an alternative way to receive your Medicare benefits along with additional coverage.
What’s Included in Medicare Advantage Coverage?
In addition to Medicare Part A (hospital stays) and Part B (medical coverage), Medicare Advantage coverage often includes extra features not found in Original Medicare alone.
- Most Medicare Advantage plans include Medicare Advantage benefits like the Medicare Part D prescription drug plan.¹
- Some plans also offer coverage for areas not normally included in regular Medicare, such as:
- Dental insurance
- Hearing insurance
- Vision insurance¹
These added benefits are a key reason many Medicare beneficiaries — including those here in Southwest Florida — consider Medicare Advantage when weighing their coverage options.
What Are the Rules for Medicare Advantage Plans?
Understanding Medicare Advantage rules is an important part of choosing the right plan.
- Medicare pays a fixed amount toward your health care to the company offering your Medicare Advantage (MA) plan.
- Beyond that fixed amount, each MA plan sets its own Medicare Advantage costs, including out-of-pocket fees — and these fees can vary from plan to plan.¹
- Depending on your specific plan, you may need to follow different rules when:
- Seeking a referral to see a specialist
- Seeking non-urgent care, even from providers within the plan’s network
Important to know: Rules, requirements, and plan features can change from year to year. It’s important to check that any changes align with the treatment or care you need before your next enrollment period.
Does Medicare Advantage Cover Prescriptions?
While most MA plans include Part D coverage for prescription drugs, not all of them do.
- One example is a Medicare Medical Savings Account (MSA) plan, which typically does not include drug coverage.
- If your plan can’t or doesn’t offer prescription drug coverage, you may be able to join a separate Medicare Prescription Drug Plan — depending on the type of Medicare Advantage plan you’re enrolled in.¹
Choosing the Right Medicare Advantage Plan
You will likely have a number of questions and concerns as you examine your options for Medicare Advantage plans. Discuss these with a trusted financial professional who can help you evaluate choices that may best fit your lifestyle and health care needs.
Frequently Asked Questions
What is Medicare Advantage?
Medicare Advantage, also known as Part C, is coverage offered by private insurers in partnership with Medicare, providing an alternative way to receive your Medicare Part A and Part B benefits along with additional features.
How does Medicare Advantage work?
Medicare pays a fixed amount toward your care to the private company offering your Medicare Advantage plan, and the plan then sets its own rules, benefits, and out-of-pocket costs beyond that amount.
What does Medicare Advantage coverage typically include?
Medicare Advantage coverage typically includes Part A and Part B benefits, often Part D prescription drug coverage, and sometimes extra benefits like dental, hearing, and vision insurance.
Do Medicare Advantage plans cover prescription drugs?
Most Medicare Advantage plans include Part D prescription drug coverage, but some, such as Medicare Medical Savings Account plans, do not. In these cases, you may be able to join a separate Medicare Prescription Drug Plan.
What rules come with a Medicare Advantage plan?
Rules vary by plan and may include requirements for referrals to see specialists or steps for seeking non-urgent care, even within the plan’s network. These rules can also change from year to year.
How much does Medicare Advantage cost?
Medicare Advantage costs vary by plan. Medicare pays a fixed amount toward your care, and each plan sets its own additional out-of-pocket fees beyond that.
- Medicare.gov, April 1, 2021
The content is developed from sources believed to be providing accurate information. The information in this material is not intended as tax or legal advice. It may not be used for the purpose of avoiding any federal tax penalties. Please consult a legal or tax professional for specific information regarding your individual situation. The opinions expressed and material provided are for general information and should not be considered a solicitation for the purchase or sale of any security.
