Medicare Advantage (Part C)

What is Medicare Advantage?

Medicare Advantage (Part C) plans are offered by private companies approved by Medicare. When you join one, you’re still in the Medicare program — you keep paying your Part B premium, and the plan takes on the job of covering your Medicare benefits.

What’s covered

Medicare Advantage plans must cover everything Original Medicare covers, except hospice care, which Original Medicare continues to cover directly. Most Medicare Advantage plans also include Part D drug coverage.

Plan types

Common plan types include HMOs, PPOs, and Special Needs Plans (SNPs, designed for people who meet specific eligibility criteria). Network and referral rules vary by plan type, so it’s worth understanding how each one works before you choose.

A yearly limit on your costs

Every Medicare Advantage plan has a yearly limit on what you pay out-of-pocket for covered Part A and Part B services. Once you reach that limit, the plan covers those costs in full for the rest of the year.

Extra benefits

Many plans offer some extra benefits Original Medicare doesn’t cover, such as certain vision, hearing, or dental services. Benefits vary by plan and by where you live, so I’ll show you what each plan available in your area actually includes.

Staying in-network

You generally need to live in the plan’s service area, and routine care is usually easiest to get in-network. Emergency and urgent care are covered anywhere in the U.S. If you travel often or split your time between two states, this is worth thinking through carefully. Some services may also require prior authorization before the plan will cover them.

Plans can change each year

Medicare Advantage plans can change their benefits, costs, and networks from one year to the next. You’ll receive an Annual Notice of Change each fall describing what’s different — a good reason to review your plan during the Annual Enrollment Period (October 15 – December 7).

Enrollment windows

The Medicare Advantage Open Enrollment Period (January 1 – March 31) lets you make one change if you’re already in a Medicare Advantage plan: switch to a different one, or return to Original Medicare and join a Part D plan.

If you join a Medicare Advantage plan when you’re first eligible at 65, you have a trial right: you can switch to Original Medicare within your first 12 months and have a guaranteed right to buy a Medigap policy. The same protection applies if you dropped a Medigap policy to try Medicare Advantage for the first time — you can go back within 12 months. Visit Medicare.gov for full enrollment period details.

May be a fit if you

• Are comfortable using a provider network
• Want your hospital, medical, and usually drug coverage combined in one plan
• Value having a yearly out-of-pocket limit
• Mostly get care close to home

How I can help

Medicare Advantage plans vary a lot from one company and county to the next. I’ll walk you through what’s actually available where you live, and how the details compare to your doctors and prescriptions. Schedule a review to go over your options.