Medicare Advantage Plans
/ Part C

What Is It

Medicare Advantage plans provide the same coverage as Medicare Parts A and B with some plans offering additional coverage, like vision and dental care. Some Medicare Advantage plans may even offer bundled prescription drug coverage.

Eligibility

To qualify to enroll in a Medicare Advantage plan, you must first qualify for Medicare Parts A and B by being age 65 or older. Those under the age of 65 with a qualifying disability who are enrolled in Medicare Parts A and B are also able to join a Medicare Advantage plan, but those with End-Stage Renal Disease (ESRD) are generally unable to enroll. If you are enrolled in Medicare Parts A and B and live within a plan’s service area, you are eligible to enroll in that plan.

Benefits

Medicare Advantage plans cover all that Medicare Parts A and B covers, including inpatient care at a hospital, Skilled Nursing Facility (SNF) care, hospice, outpatient care, durable medical equipment, home health care, and some preventive care. In addition to these benefits, some Medicare Advantage plans may offer dental care, eyeglasses, wellness programs, and/or prescription drug coverage.

Enrollment

When you first become eligible for Medicare, you have the option of enrolling in a Medicare Advantage plan during your Initial Enrollment Period, a 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month that you turn 65. Additionally, each year from October 15 to December 7, you have the opportunity to add or switch Medicare Advantage plans during the Annual Election Period (AEP).

Possible Plan Options

Private insurance companies offer Medicare Advantage plans so availability and cost may differ by location, but there are six main types of Medicare Advantage plans out there: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service Plan (PFFS), HMO Point-of-Service Plan (HMOPOS), Special Needs Plan (SNP), and Medicare Medical Savings Account Plans (MSA). While same type plans may offer similar coverage, costs may vary between private insurance companies.

Costs

The costs associated with a Medicare Advantage plan can differ by private insurance company offering it, but all beneficiaries are responsible for covering the Part B premium as well as an additional monthly plan premium for the Medicare Advantage plan coverage. Premiums can vary so it is recommended that you shop around to find the right plan for your needs.

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