The Medicare Advantage program (also called "Medicare Part C") consists of health plans offered by private insurance companies that have a contract with Medicare. If a person with Medicare chooses to enroll in a Medicare Advantage plan, their Part A (Hospital) and Part B (Medical) benefits are then administered by the Medicare Advantage plan they choose - instead of being administered by Medicare directly. In other words, it is simply another way for you to receive your Medicare benefits. To be eligible for enrollment in a Medicare Advantage plan you must first have both Medicare A & B and live in the plan’s service area.

What Does It Cover?

Medicare Advantage plans are required to cover everything Original Medicare covers. However, the cost sharing (i.e. deductibles, co-pays and co-insurance) you are responsible for is done a little differently. For example, a doctor office visit on a Medicare Advantage plan may be a nominal co-pay - whereas on Original Medicare you would first have to meet the Part B deductible and then be responsible for 20% of charges for that doctor office visit. Many Medicare Advantage plans also cover Part D prescription drugs which eliminates the need to enroll in a standalone prescription drug plan.

How Much Does It Cost?

Medicare Advantage premium amounts depend on where you live. In many instances (particularly in densely populated areas), Medicare Advantage premiums tend to be lower than Medicare supplement premiums.  

Click here for Medicare Advantage plan options and rates in your area.

Reasons Why Some People Prefer Medicare Advantage Plans

Medicare Advantage plans are a convenient way to receive your Part A (hospital), Part B (medical) and in most cases Part D (prescription drug) benefits. It is also a good option for people who are looking to save money but still want a health plan with robust benefits. Medicare Advantage plans may also offer extra benefits beyond what Medicare covers – which can go a long way in helping their plan members stay healthy, active and save money on other qualified products & services.

Things To Consider Regarding Medicare Advantage Plans

Most Medicare Advantage plans are network based – which means you could end up being responsible for 50% - 100% of the cost if you go outside the network for non-emergency routine services.

Example 1: If you are enrolled in a Medicare Advantage HMO plan, you must only see providers within a particular network.  Otherwise you may be responsible for 100% of the cost (except for emergencies). 

Example 2: If you are enrolled in a Medicare Advantage PPO plan and you see a provider outside the preferred provider network, you may be responsible for up to 50% of the cost (except for emergencies).  

Before deciding on any Medicare Advantage plan, be sure to do your due diligence and make sure the medical providers you wish to see will accept the plan(s) you are considering. This could be the difference between a health plan that meets all of your needs versus having your health care choices adversely impacted.

The Bottom Line

With very few exceptions, Medicare Advantage plans have provider networks. These plans can be a very good fit for people who are looking to save money on premiums and understand that they can only see doctors within a specific network. This is particularly true for those who have had an HMO or PPO plan in the past and/or their doctors are already in one network (or at least they are willing to change their doctors if necessary). Other people may see medical providers critical to their care who do not accept network based plans - or perhaps they live in an area where HMO and PPO networks are far and few between. In cases like this, a Medicare supplement (also known as "Medigap") may be a better option.