What is Medicare Advantage?

Medicare Advantage (Part C) is an all-in-one solution for Medicare that offers at least the benefits of Medicare Parts A and B, and typically Part D, through a private insurer.[1]

Medicare Advantage Basics

  • Medicare Part C is called Medicare Advantage. Sometimes people call these plans “Advantage plans” for short.
  • If you have Medicare Advantage, you still have Medicare.
  • You must already have Original Medicare Parts A (hospital insurance) and B (medical insurance) to qualify for an Advantage plan.
  • Medicare Advantage must cover at least what Original Medicare does.
  • There are many different types of Advantage plans in terms of benefits and cost-sharing. Some plans have higher premiums, more benefits, and better cost-sharing than Original Medicare. Some reduce premium costs by creating a limited network of doctors you can see. Some offer drug coverage and some don’t. Some are designed for people with Special Needs. The right plan for you depends on your specific needs and the selection of plans in your county.
  • Medicare Advantage plans can cover drugs and come bundled with a Part D plan. This makes many Advantage plans an alternative to Original Medicare only with a Standalone Part D plan or Medigap with a Standalone Part D plan (although you can have Part C and Part D if your Part C plan doesn’t cover drugs).
  • Medicare Advantage has unique enrollment and dis-enrollment periods.
  • You’ll still pay your Part B premium alongside your Part C premium, although all your claims are paid from your Advantage plan.

What Does Medicare Advantage Cover?

While Medicare Advantage plans must offer at least the benefits offered by Original Medicare Parts A and B, Advantage plans often offer additional benefits Original Medicare doesn’t.

Most Advantage plans offer some vision, hearing, dental, and fitness programs, and some plans offer services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness (like gym memberships).

Meanwhile, some Medicare Advantage plans are designed for special needs. Some Special Needs Medicare Advantage plans cover specific chronic conditions, others are for dual-eligible Medicare/Medicaid, and others are designed for institutional care.

Advantage plans don’t just offer additional benefits though, they can also act as an all-in-one solution, by both “filling in the gaps” like with Medicaid Like Medigap (for example by covering Part A and B deductibles) and by offering drug plans (many Advantage plans come bundled with Part D drug plans).

What Does Medicare Advantage Cost?

Medicare Advantage plan premiums can be as low as $0. Advantage plan costs are generally based on the plan’s cost-sharing and what benefits it offers. A plan with low maximums, generous drug cost-sharing, and coverage for many benefits will generally cost more, while plans without much additional cost-sharing may have little-or-no monthly costs.

To get a sense of what a plan costs, what cost-sharing they offer, and what benefits are covered, we suggest trying the plan search at the top of our site and checking out plans in your area.

FACT: Some plans offer add-on packages for dental, vision, and hearing. These packages will add extra costs and coverage to your plan.

FACT: Medicare Advantage costs can be impacted by income due to the way Part A, B, and D costs can be lowered based on income

Citations

  1. Medicare Advantage Plans cover all Medicare services. Medicare.Gov.