Medicare Advantage Plans
Medicare Advantage, also called Part C, is an alternative way to receive Medicare Part A and Part B benefits through a private insurance company approved by Medicare.
Combined coverage
Plans provide Part A and Part B benefits. Most include Part D prescription drug coverage, and some offer additional benefits.
Plan networks
HMO, PPO, PFFS, and Special Needs Plans can use different networks, referral rules, and out-of-network provisions.
Predictable service costs
Instead of Original Medicare’s 20% coinsurance for many Part B services, plans may use copayments or coinsurance that vary by service.
Annual medical limit
Each plan has an annual maximum out-of-pocket limit for covered Part A and Part B services. The amount varies by plan.
What to compare before enrolling
- Doctors, hospitals, specialists, and pharmacies in the plan’s network.
- Prescription formulary, drug tiers, prior authorization, step therapy, and quantity limits.
- Monthly premium, medical deductible, drug deductible, copays, coinsurance, and maximum out-of-pocket limit.
- Dental, vision, hearing, transportation, fitness, over-the-counter, or other supplemental benefits.
- Service area, travel needs, and rules for non-emergency care outside the network.
Questions about this coverage?
Larry Bellinger Jr can help explain general coverage concepts and the options available in your area.