Medicare Part C
Medicare Advantage Plans
Medicare Advantage, sometimes called Part C, is offered by private insurance companies that contract with Medicare. These plans bundle your Part A and Part B coverage into a single plan, and most include prescription drug coverage as well.
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Hospital and medical coverage in one plan
Part A and Part B benefits are combined into a single plan with a single card, rather than managed separately.
Prescription drug coverage is usually included
Most Medicare Advantage plans include Part D coverage. Plans that do are often called MA-PD plans.
Benefits Original Medicare does not cover
Many plans offer additional benefits such as dental, vision, hearing, or fitness. What is offered varies by plan and by area.
A yearly limit on what you pay
Medicare Advantage plans have an annual out of pocket maximum for covered services. Original Medicare does not have one.
How Medicare Advantage works
When you enroll in a Medicare Advantage plan you stay in the Medicare program, but your coverage is administered by the private company offering the plan rather than by Original Medicare.
Plans are offered by service area, so the options available to you depend on where you live. Most plans use a provider network, and some require you to choose a primary care provider or get a referral before seeing a specialist.
Types of Medicare Advantage plans
- HMO
- Generally requires you to use providers in the plan network, and often requires a referral to see a specialist.
- PPO
- Lets you see providers outside the network, usually at a higher cost to you.
- PFFS
- Sets its own payment terms with providers. Not every provider will accept the plan.
- SNP
- Special Needs Plans, limited to people with a specific condition or circumstance, including people who also have Medicaid.
What you may pay
- Your Part B premium
- You continue to pay your Medicare Part B premium when you are enrolled in a Medicare Advantage plan.
- A plan premium
- Some plans charge a monthly premium in addition to your Part B premium. Some do not. This varies by plan and by area.
- Copays and coinsurance
- You may pay a set amount or a percentage when you receive care, depending on the service and the plan.
- A deductible
- Some plans have a deductible you pay before the plan begins paying its share.
Who can enroll
- You are enrolled in both Medicare Part A and Part B.
- You live in the plan’s service area.
- You enroll during a period when you are eligible to make a change.
When you can enroll
Initial Enrollment Period
7 months around your 65th birthday
Begins 3 months before the month you turn 65, includes that month, and ends 3 months after. This is when most people first enroll, and enrolling early in the window generally means coverage starts sooner.
Annual Enrollment Period
15 October to 7 December
Each autumn you can join, switch, or drop a Medicare Advantage or Part D plan. Changes made during this window generally take effect on 1 January.
Medicare Advantage Open Enrollment
1 January to 31 March
If you are already in a Medicare Advantage plan you can switch to a different one, or return to Original Medicare, once during this window. It is not available to people who are in Original Medicare on 1 January.
General Enrollment Period
1 January to 31 March
For people who did not sign up for Part B when first eligible and do not qualify for a Special Enrollment Period. A late enrollment penalty may apply.
Medigap Open Enrollment Period
6 months from Part B enrollment at 65
Begins the month you are both 65 or older and enrolled in Part B. During it you can buy any Medigap policy sold in your state regardless of your health. It does not repeat.
Special Enrollment Period
When your circumstances change
Certain life events, such as moving or losing other coverage, can open a window to make a change outside the usual periods. How long it lasts depends on the event.
Frequently asked questions
Other coverage options
Prescription Drug Plans
Medicare Part D helps cover the cost of prescription drugs. It is offered by private insurance companies approved by Medicare, either as a standalone plan or built into a Medicare Advantage plan.
D-SNPDual Eligible Special Needs Plans
A Dual Eligible Special Needs Plan, or D-SNP, is a type of Medicare Advantage plan for people who have both Medicare and Medicaid. It is designed to coordinate the two programs in a single plan.