A Medicare Advantage plan is a private health insurance plan approved by Medicare. You may opt to get your Part A, B and D benefits from a Medicare Advantage plan instead of traditional Medicare. Originally called Part C, these Medicare private insurance plans usually have an HMO or PPO network of doctors.
Medicare Advantage Explained
Medicare Advantage plans were created as an alternative to Original Medicare and Medigap. By joining one of these plans, you direct Medicare to pay the Advantage plan a set monthly amount for your care. In return, the plan will deliver all of your Part A & Part B services. They take on all of your medical risk.
You must continue to pay your Medicare Part B premium while enrolled in an Advantage plan. You must be enrolled in both Medicare Parts A and B and live in the plan’s service area.
Medicare Advantage policies are NOT Medigap plans. They work differently because they pay instead of Medicare, not after Medicare. Learn more about how Medicare Advantage works here.
Medicare Advantage Coverage
Many people new to Medicare will ask us for the pros and cons of Medicare Advantage plans vs Original Medicare. Much of this is in the way you access your benefits.
With Original Medicare, you will have deductibles and a 20% coinsurance on Part B. You can visit any doctor or hospital that participates in Medicare, and most do.
With an Advantage plan, you will use the plan’s network of providers, which is usually local. You will pay co-payments when you receive healthcare services. Each plan sets its own cost-sharing. For example, you might pay a small copay for a primary care doctor visit, and perhaps a higher copay to see a specialist. Likewise, some plans will charge you a daily hospital copay, and other plans might charge a flat amount for the whole stay.