A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans" are offered by private companies approved by Medicare.If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.
Different Types of Medicare Advantage Plans:
There are other less common types of Medicare Advantage Plans
HMO Point of Service (HMOPOS) Plans‚ An HMO plan that may allow you to get some services out-of-network for a higher cost.
The type of health care services you need and how often you get them.
In all types of Medicare Advantage Plans, you are always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you are in a Medicare Advantage Plan. Medicare Advantage Plans aren't supplemental coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
New‚ Making changes to your coverage after December 31 Between January 1‚ February 14, 2011, if you are in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.(Learn More About Medicare Guidelines)
During this period, you can't do the following:
As with Original Medicare, you still have Medicare rights and protections, including the right to appeal.
Check with the plan before you get a service to find out whether they will cover the service and what your costs may be. You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan.
You can join a Medicare Advantage Plan even if you have a pre existing condition, except for End-Stage Renal Disease.
You can only join a plan at certain times during the year. In most cases, you’re enrolled in a plan for a year.
If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan.