Medicare Advantage (Part C)

What Is Medicare Advantage? What Does It Cover?

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Medicare Advantage plans, also known as Medicare Part C, provides Medicare coverage through private health insurance companies approved to participate in the federal government’s Medicare program. These plans can be HMOs (health maintenance organizations), PPOs (preferred provider organizations), Regional PPOs, or Private Fee-for-Service Plans.

Medicare Advantage plans provide all Medicare Part A and Medicare Part B services and also include additional services, such as vision services, hearing aids, and wellness programs. These plans also tend to have an overall lower cost and a maximum that you would have to pay for out-of-pocket costs each calendar year. This feature is not available through Original Medicare.

Limitations and Salient Features

Limitations: Medicare Advantage plans have well defined geographic service areas and most have networks of physicians and hospitals where you can receive medical care. Before you visit any clinic, ask the physician if they participate in your health insurance plan’s Medicare Advantage network.

Salient Features:

  • Premium - All Medicare Advantage plans require that you continue to pay your Part B insurance premium. You might also have to pay a separate monthly insurance premium for your Medicare Advantage plan.
  • Deductibles - Some plans have deductibles.
  • Copays - A copayment may apply to specific services, such as doctor office visits.
  • Coinsurance - Cost-sharing amounts may apply to specific services.
  • Out-of-Pocket Expenses - All Medicare Advantage plans have an annual limit on your out-of-pocket expenses. The OOP limit can be as low as $1500 and as high as but no higher than $6700.

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