Medicare Part C, also called Medicare Advantage (MA), are private insurance plans offered by Medicare-approved companies. These plans provide most of Part A (Hospital Insurance) and Part B (Medical Insurance) coverage and typically offer extra benefits such as vision, hearing and dental care. Some Part C plans also include Medicare Part D prescription drug coverage (MAPD plans).

What does Medicare Advantage cover?

Medicare Advantage plans cover all the inpatient and outpatient services that Medicare Part A and Part B cover, except clinical trials and hospice services.

If you enroll in a Medicare Advantage plan, Original Medicare will still help cover the cost for hospice care, some new Medicare benefits and some costs for clinical research studies.1

Some of the medically necessary services covered by Medicare Advantage plans and Original Medicare include:

  • Primary care and specialist doctor visits
  • Laboratory tests
  • X-rays
  • Emergency ambulatory services
  • Durable medical equipment
  • Preventive tests and vaccines
  • Physical therapy

Medicare Advantage plans can also include prescription drug coverage. To get the same coverage with Original Medicare, you’d have to buy a separate prescription drug plan and pay a separate premium.

Extra benefits included with a Medicare Advantage plan

Since MA plans are offered by private companies, they can be customized with extra benefits. Some benefits may provide coverage for:

  • Routine dental care (dental exams, X-rays, teeth cleanings)
  • Routine vision care (eye exams, eyeglasses and contacts)
  • Routine hearing care (hearing tests, hearing aids)
  • Fitness programs
  • Gym memberships
  • Transportation to doctor visits
  • Over-the-counter drugs

MA plans can also be customized to treat specific conditions and diseases.

What’s the difference between Medicare Advantage and Original Medicare?

The main difference is Medicare Advantage plans are offered by private companies and Original Medicare is administered by the federal government.

To learn more about the differences, check out this helpful side-by-side comparison of Original Medicare and Medicare Advantage.

Types of Medicare Advantage plans

Here’s a quick look at some common Medicare Advantage plans:
Plan Details Health Maintenance Organization (HMO)

HMOs may offer lower premiums than other plans. You must usually stay within your plan’s network for care and services.

 
Preferred Provider Organization (PPO)

PPOs may allow you to go out-of-network for care. You will usually pay less if you stay within the plan’s network.

 
Private Fee-For-Service (PFFS)

A PFFS plan may or not be network-based and requires non-network providers to accept Medicare reimbursement and the plan’s terms.

 
Special Needs Plan (SNP)

SNPs are designed for people with chronic conditions such as diabetes, and individuals who qualify for both Medicare and Medicaid.

 
Medical Savings Account (MSA)

MSAs combines a high-deductible plan with a designated savings account. These plans do not include prescription drug coverage.

 
HMO Point-of-Service (HMO-POS)

These hybrid HMOs let you go outside the network for treatment but may have a higher cost. There can be separate deductibles for in-network and out-of-network costs.

 
For more detailed information, see comparing Medicare Advantage plans.

How much do Medicare Advantage plans cost?

The cost for Medicare Advantage plans depend on the plan and the company. The average premium for a Medicare Advantage plan in 2022 is $19 per month, but there are other costs to consider, such as copays and deductibles.2

How to enroll in Medicare Advantage plans

Your first chance to sign up for Medicare Advantage is during your Medicare Initial Enrollment Period (IEP). The IEP for Medicare starts 3 months before the month you turn 65 and ends 3 months after.

If you have Original Medicare and want to enroll in Medicare Advantage for the first time, you can choose a Medicare Advantage plan during Medicare’s Annual Enrollment Period (AEP). Medicare’s AEP runs from Oct. 15 to Dec. 7.

If you’re already enrolled in Medicare Advantage, you can switch plans during the Medicare Advantage Open Enrollment Period (OEP). The Medicare Advantage OEP runs from Jan. 1 to March 31, or the annual enrollment period for Medicare.

Do I need a Medicare Advantage plan?

Everyone has different health needs. If you have a chronic condition or need routine medical care, the comprehensive coverage of a Medicare Advantage could make sense. Set aside time to research MA plans that fit your needs, make a list and choose the 1 that benefits you the most.

Humana answers your Medicare questions

How can we help?

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Sources

  1. “Medicare Advantage Plans cover all Medicare services,” Medicare.gov, last accessed September 13, 2022, https://www.medicare.gov/what-medicare-covers/what-medicare-health-plans-cover/medicare-advantage-plans-cover-all-medicare-services.
  2. “CMS Releases 2022 Premiums and Cost-Sharing Information for Medicare Advantage and Prescription Drug Plans,” Centers for Medicare & Medicaid Services, last accessed September 13, 2022, https://www.cms.gov/newsroom/press-releases/cms-releases-2022-premiums-and-cost-sharing-information-medicare-advantage-and-prescription-drug.