Medicare Advantage plans
What is Medicare Advantage (Part C)?
A Medicare Advantage (Part C) plan combines Original Medicare Part A (hospital insurance) and Part B (medical insurance) in one plan. It usually includes prescription drug coverage and may offer additional benefits such as dental, vision and fitness, often at no additional premium charge.
Is it different from Original Medicare?
Yes. Original Medicare plans come directly from the federal government. Medicare Advantage plans are offered by private insurance companies.
Is it different from Medicare Supplement insurance?
Yes. Medicare supplement insurance, also called Medigap, is also available from private insurance companies. Medigap adds to Original Medicare while Medicare Advantage replaces it.
Is it different from Medicare Part D?
Yes. Medicare prescription drug (Part D) plans are generally used in addition to Original Medicare. Most Medicare Advantage plans also include prescription drug benefits.
What Medicare Advantage plans are available to me?
Medicare Advantage plans operate within defined geographic regions called service areas. To join a plan, you need to live in its service area. Coverage and costs can vary by plan and location.
Who should enroll in a Medicare Advantage plan?
Anyone who is eligible for Original Medicare can choose a Medicare Advantage plan. To find which plan best fits your needs and budget, start with a plan comparison tool.
What do Medicare Advantage plans cover?
All Medicare Advantage (Part C) plans cover:
- All Medicare Part A (hospital) benefits (hospice coverage may be provided, but if not, will still be covered by Part A)*
- All Medicare Part B (medical) benefits
Most Medicare Advantage Plans Cover:
- Prescription drugs
Additional benefits Medicare Advantage plans may offer:
- Dental exams, cleanings and X-rays
- Eye exams, eyeglasses and corrective lenses
- Hearing tests and hearing aids
- Wellness programs and fitness memberships
- Other extra benefits such as transportation to medical appointments and virtual provider visits
*Even if you have a Medicare Advantage plan, hospice care will still be paid for you by Original Medicare Part A.
Important things to remember about Medicare Advantage plans
- Some plans will have provider networks, some will not
- Out-of-pocket cost limitations can vary by plan
- Plan premiums can vary by plan, with different ones offered to fit different budgets
View Medicare Advantage plans in your area
See all of the UnitedHealthcare and AARP Medicare Plans where you live.
What types of Medicare Advantage plans are there?
Coordinated care plans
Most Medicare Advantage (Part C) plans are coordinated care plans. Coordinated care plans have a network of providers. If you use the plan's network of providers, you generally pay less out-of-pocket for care.
Health Maintenance Organization (HMO) plans
HMO plans use a network primary care provider (PCP) to help coordinate care. HMO plans usually only pay for providers in the plan network.
Point of Service (POS) plans
POS plans have the benefits of an HMO plan, but with more flexible provider choices. Costs are generally lower if you use the plan's network providers.
Preferred Provider Organization (PPO) plans
PPO plans cover providers both in and out of network. These plans pay a portion of the cost for using an out-of-network provider.
Special Needs Plans (SNPs)
Special Needs Plans have benefits that cover special health care or financial needs. All SNPs include prescription drug coverage.
- Dual-Eligible Special Needs Plans (D-SNPs) for people who have both Medicare and Medicaid (called "dual eligible")
- Chronic Special Needs Plans (C-SNPs) for people living with severe or disabling chronic conditions
- Institutional Special Needs Plans (I-SNPs) for people who live in a skilled nursing facility
- Institutional-Equivalent Special Needs Plans (IE-SNPs) for people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility
Other types of Medicare Advantage plans
If you want more freedom in health care providers or payment options, there are 2 other types of Medicare Advantage (Part C) plans to consider.
Private Fee-for-Service (PFFS) plans
PFFS plans may or may not have a provider network, but they cover any provider who accepts Medicare. If the plan doesn't include Part D prescription drug coverage, you can also enroll in a stand-alone Part D plan separately.
Medical Savings Account (MSA) plans
MSA plans combine a high-deductible health plan with a special savings account. Medicare deposits funds that are withdrawn tax free to pay for qualified health care services. You can see any provider you choose. MSA plans don't include Part D prescription drug coverage, but you can enroll in a stand-alone Part D plan separately.
Not all plans are available in all areas.
Are you a veteran?
Some Medicare Advantage plans are designed to complement the benefits you have for your service.
How Much does a Medicare Advantage Plan cost?
Each Medicare Advantage (Part C) plan sets its own specific costs, but the types of costs they include are similar. The table below shows the types of costs that plans may apply, but you need to look at the details of a particular plan for actual costs.
For most medical services, such as doctor visits
For select items, such as durable medical equipment
Plan premiums vary. You still pay your Part B premium (and Part A premium, if you have one) to Medicare.
Some plans charge an annual deductible, and some do not. Original Medicare Part A and Part B deductibles don't apply.
Many plans charge copays for the services and benefits you use.
Plans set their own coinsurance terms and percentages.
How Medicare Advantage cost sharing works
Most Medicare Advantage (Part C) plans use a combination of deductibles, co-insurance and co-pays to share the cost of the services you use. Cost-sharing usually applies to all the services the plan covers.
You need to read the details of each individual Medicare Advantage plan to get the full story on its costs. Most plans have network doctors and pharmacies that may offer plan members discounted pricing.
See How Medicare Costs May Work With These Medicare Coverage Examples
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