Medicare Advantage, also called Part C, is an alternative to Original Medicare (parts A and B). Part C plans are offered by private insurers.
Original Medicare includes only Part A (hospital insurance) and Part B (medical insurance). You can enroll in an additional plan to help cover prescription drugs (Part D).
You can also enroll in a supplemental insurance plan, also called Medigap. This can help cover your out-of-pocket costs from Original Medicare.
Part C is an alternative to Original Medicare that must offer the same hospital and medical insurance as parts A and B. Many Part C plans also include prescription drug coverage. Simply put, Part C plans often bundle parts A, B, and D into one.
Part C plans may also include additional benefits not available with Original Medicare.
All Part C plans include the same basic services the government provides under Original Medicare, such as:
- inpatient hospital care
- limited stays at a skilled nursing facility
- limited stays at an inpatient rehabilitation facility
- outpatient care at a doctor’s office, urgent care center, health center, or clinic
- inpatient and outpatient mental health services
- preventive care, including routine exams, shots, lab tests, and screenings
- limited outpatient prescription drugs
- durable medical equipment
- ambulance transport
Unlike Original Medicare, Part C plans do not cover:
- clinical trials
- hospice care
- the cost of getting a kidney for an organ transplant
Many Part C plans offer additional benefits to support overall health and wellness. Most Part C plans include coverage for:
- prescription drugs
- routine vision, hearing, and dental care
- fitness programs
- over-the-counter items
- telehealth and other remote-access technologies
- meal delivery or other services
Some Part C plans include coverage for:
- transportation to doctor visits
- acupuncture
- bathroom safety devices
- in-home support services
- caregiver support services
- telemonitoring services
You can enroll in only one of two options: Original Medicare or Medicare Advantage. You cannot enroll in both.
If you’re new to Medicare, you can sign up for any plan during your initial enrollment period. Most people become eligible for Medicare at age 65 years.
If you initially enrolled in Part A only and now need Part B coverage, you can enroll in a Part B plan or switch to Part C.
If you’re already enrolled in parts A and B, you can switch from Original Medicare to Medicare Advantage during open enrollment. Open enrollment begins on October 15 and ends on December 7.
Some people may be able to join or switch to Part C during a special enrollment period. You may be eligible if you’re:
- moving to a new location
- losing or changing your current coverage
- getting Medicaid
- getting Extra Help
Consult with your benefits administrator before changing your health insurance coverage. Joining a Part C plan may cause you to lose your employer or union coverage for yourself, your spouse, or your dependents.
If you have additional questions about enrollment or are unsure what to choose, consider contacting your local State Health Insurance Assistance Program (SHIP). SHIP provides free, unbiased, one-on-one insurance counseling.
According to the nonprofit KFF, the average person will be able to access 43 different Medicare Advantage plans in 2024.
Over half (56%) are health maintenance organization (HMO) plans. However, preferred provider organization (PPO) plans are increasing in popularity (up from 24% in 2017 to 42% in 2024).
Plans limited to certain populations are less common. This includes:
- Private Fee-for-Service (PFFS) plans
- Special Needs Plans (SNP)
- Medical Savings Accounts (MSA)
Most plans distinguish between in-network and out-of-network care. You typically need a referral to meet with a specialist, and you may need prior authorization before your plan covers a certain drug or service.
The most common insurance providers include:
- Humana
- UnitedHealthcare
- Blue Cross Blue Shield
- Aetna
- Cigna
- Kaiser Permanente
Each Part C plan sets its own cost and coverage amounts. The premiums, deductibles, copayments, and coinsurance amounts you’ll pay depend on your chosen plan.
Staying in network — which is when you get care from a predetermined list of healthcare professionals and facilities — usually costs less than going out of network.
Premiums
HMO, PPO, and PFFS plans usually charge a monthly premium in addition to monthly Part B premiums. But some plans may help pay all or part of your Part B premiums. This is known as a Medicare Part B premium reduction.
Some SNPs charge a monthly premium in addition to monthly Part B premiums. Yet most of the premium costs will be covered if you have Medicare and Medicaid.
MSAs don’t have premiums, but you must continue to pay your monthly Part B premium.
The higher your income, the higher your Part B premium will be. In 2024, you’ll pay at least $174.70 per month.
Out-of-pocket costs
PPO plans usually offer out-of-network coverage for a higher copayment or coinsurance.
HMO plans with added Point of Service (POS) benefits (HMO-POS plans), some PFFS plans, and some SNPs also offer out-of-network coverage at an increased cost.
MSAs have two parts: a high deductible insurance plan and a savings account you can use to pay for healthcare costs. If you use all the money in your savings, you’ll have to pay out of pocket until you meet your deductible.
Medicare Advantage (Part C) is an alternative to Original Medicare (parts A and B).
Part C plans usually bundle coverage from parts A, B, and D. Most Part C plans offer additional coverage, including vision, hearing, dental, and fitness benefits.
Unlike Original Medicare, Medicare Advantage limits what you’ll pay out of pocket each year for covered services.
Once you pay the plan’s out-of-pocket maximum, it will pay 100% of the costs for covered health services for the rest of the calendar year.