As you probably know, Medicare is the federal insurance plan for people aged 65+, some younger people with disabilities, and people with End-Stage Renal Disease. It includes:

• Hospital Insurance (Part A)
• Medical Insurance (Part B)
• Prescription drug coverage (Part D)

Medicare Advantage, also known as Part C, is an all-in-one alternative to Medicare, and it provides Medicare benefits through a private-sector insurer. Medicare Advantage covers everything that was already covered by Medicare, plus a few extra services, such as dental and vision, and hearing. The services included in MA Plans are provided by private companies, which must follow Medicare terms.

If you get Medicare Advantage, you’ll still get the services included in Part A and B, but they’ll be covered by Medicare Advantage, not the original Medicare.

Medicare Advantage Plans And How They Work

There are several Medicare Advantage Plans you can choose from, depending on what you need. Each of these plans comes with its terms, such as whether or not you need a referral to see a specialist or how much you pay out of your pocket. Keep in mind that the plans are subject to change.

All Medicare Advantage Plans cover emergency care. You’ll get coverage for:

• Part A and Part B services
• Extra services such as dental, hearing, vision, fitness programs, medical transportation, and more.
• Most Medicare Advantage Plans also include Part D.

Anyone can join a Medicare Advantage Plan, as long as they already have Part A and Part B and they live in the service area.

There are several types of Medicare Advantage Plans:

Health Maintenance Organization (HMO) plans: In most HMOs, you may only go to doctors, other health care providers, or hospitals that are in the plan’s network, except in an emergency or urgent situation. You probably also need to get a referral from your primary care doctor for diagnostic tests or to see other doctors or specialists.

Preferred Provider Organization (PPO) plans: With a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You generally pay more if you use doctors, hospitals, and providers outside of the network.

Private Fee-for-Service (PFFS) plans: PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they agree to accept the plan’s payment terms. The plan will determine how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Special Needs Plans (SNPs): SNPs provide specialized and focused health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.

HMO Point-of-Service (HMO-POS) plans: These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.

Medical Savings Account (MSA) plans: These plans combine a high-deductible health plan with a bank savings account. Medicare will deposit money into the account (usually less than the deductible). You can use the money to pay for your health care services throughout the year. MSA plans do not offer any Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan, Part C of Medicare.

To be eligible to enroll in a Medicare Advantage plan you must have both Medicare Parts A and B and live in the plan’s service area. People with End-Stage Renal Disease (permanent kidney failure) generally cannot enroll in a Medicare Advantage Plan.

You must continue to pay your Part B premium and generally pay one monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join. Some may have a $0 premium.

Medicare Advantage Plans have to cover all of the services that Original Medicare covers except for hospice care. Original Medicare will cover hospice care even if you are in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you will always be covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs.

Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay one monthly premium for both the plan’s medical and prescription drug coverage.

Remember, plan benefits can change from year to year. Make sure you understand how a plan works before you join.