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Part C – Medicare Advantage

What are Medicare Advantage plans?

Medicare Advantage plans are private health plans that have contracts with Medicare. When you join one, you get your Medicare-covered health care services through the private plan.

Medicare Advantage plans must cover all the same things as Medicare Part A and B. They also may cover services that Original Medicare does not pay for. Examples are eye exams or a pair of eyeglasses each year, or a hearing exam. They may charge different amounts than you would pay through Original Medicare.

Medicare Advantage plans may also cover prescription drugs. If they do, you cannot buy a separate Medicare prescription drug plan.

With Medicare Advantage plans, you generally must use certain providers. These are doctors, hospitals, drugstores, and other health care providers that the plans have contracts with. These are called in-network providers. If you use providers outside your plan's network, it may cost you more money. It also may mean you get no Medicare coverage at all for that service.

You must have Medicare Parts A and B to join a Medicare Advantage plan. You pay your usual Part B premium plus any additional premium that the plan may charge.

Note: The Part B premium usually comes out of your Social Security check automatically. Be sure you understand the rules of Medicare Advantage plans before you enroll.

What are the different types of Medicare Advantage plans?

There are several different types of Medicare Advantage plans. These are the most common:

Types of Plans
Health Maintenance Organizations (HMOs) If you do not get your care from a provider the HMO approves, called an in-network provider, Medicare will not cover it.You usually need a referral from your primary care provider to see a specialist.
Preferred Provider Organizations (PPOs) You can get care from a Medicare provider out of your network. But you will pay more for out-of-network care.You will not need a primary care doctor.
Private Fee-for-Service plans (PFFS) There is no network of providers.You can see any Medicare provider who agrees to the plan's terms and payments.Providers can decide on a case-by-case and visit-by-visit basis whether or not to see you.
Special Needs Plans (SNPs) These are PPOs or HMOs that only admit people with Medicare who:

  • Have certain serious chronic medical conditions, or
  • People who have Medicaid and Medicare, or
  • People who live:
    • In certain nursing homes or
    • At home but have high care needs and could qualify for a nursing home.
Medical Savings Accounts (MSAs) You must pay a very high deductible before the plan covers any benefits. A health savings account is linked to the plan.Medicare puts money in the savings account each year, but the amount is less than your annual deductible.

Can I have a Medicare Advantage plan and supplemental insurance?

If you choose to enroll in a Medicare Advantage plan, you cannot also buy a Medigap/supplemental insurance policy. Learn more about the differences between Medicare Advantage and Medigap, and why you might choose one over the other. Understand, too, that if you choose to enroll in Medicare Advantage, you will have limited opportunities to get a Medigap policy in the future if you wish to switch back to Original Medicare.

Get personal help to determine whether a Medicare Advantage plan might be best for your situation.

Aon Hewitt Navigators® is a Medicare insurance brokerage service recommended by NCOA because it meets rigorous Standards of Excellence established by NCOA. You may be eligible for personal one-on-one assistance in selecting and enrolling in health coverage. All of the services are provided at no cost to consumers. Check to see if you are eligible.

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