Medicare Advantage (Part C)

Medicare Advantage plans provide Medicare coverage through private health insurance companies approved to participate in the Medicare program. These plans can be HMOs, PPOs, Regional PPOs or Private Fee-for-Service plans.

Medicare Advantage plans provide all Part A and B services while generally including some additional services, such as wellness programs, hearing aids and vision services. These plans also tend to have lower cost sharing overall and a maximum that you would have to pay for out-of-pocket costs each calendar year–a feature not available through Original Medicare.

 Medicare Parts A and B (Original Medicare) are managed by the federal government. Some individuals who receive Social Security benefits are automatically enrolled in Original Medicare while others need to apply for it as they approach their 65th birthday. 

Medicare Prescription Drug plans are offered by private health insurance companies and cover your prescription drug costs for covered medications.

You can choose to receive this coverage in addition to:

• Original Medicare (Part A and Part B)
• Original Medicare (Part A and Part B) with a Medigap Plan

Part D coverage is generally included in most Medicare Advantage (Part C) plans.

If you are enrolled in Medicare Part A and B (Original Medicare), Medigap plans can help fill the coverage gaps in Medicare Part A and Part B. Medigap plans are sold by private insurance companies and are designed to assist you with out-of-pocket costs (e.g., deductibles, copays and coinsurance) not covered by Parts A and B. These plans are available in all 50 states and can vary in premiums and enrollment eligibility. Medigap plans are standardized; however, all of the standardized plans may not be available in your area. 

Things to Consider

• Medicare Advantage plans (such as PPO and HMO plans) generally include prescription drug coverage.

• Your annual costs may vary depending on the premiums, copayments, coinsurance and benefits of the plan you select.

• Medicare Advantage plans may have copayments or cost sharing amounts on Medicare covered services that differ from the cost sharing amounts in Original Medicare.

• Medicare Advantage plans may change their monthly premiums and benefits each year. This also occurs in Original Medicare, as Part B premiums, standard deductibles and cost sharing amounts generally change annually on January 1.

• Medicare Advantage plans have defined geographic service areas and most have networks of physicians and hospitals where you can receive care. Ask your physicians if they participate in your health insurance plan’s Medicare Advantage network.