Medicare Advantage Plans
Medicare Advantage, also called Part C, is an alternative way to receive Medicare Part A and Part B benefits through a private insurance company approved by Medicare.
Combined coverage
Plans provide Part A and Part B benefits. Most include Part D prescription drug coverage, and some offer additional benefits.
Plan networks
HMO, PPO, PFFS, and Special Needs Plans can use different networks, referral rules, and out-of-network provisions.
Predictable service costs
Instead of Original Medicare’s 20% coinsurance for many Part B services, plans may use copayments or coinsurance that vary by service.
Annual medical limit
Each plan has an annual maximum out-of-pocket limit for covered Part A and Part B services. The amount varies by plan.
What to compare before enrolling
- Doctors, hospitals, specialists, and pharmacies in the plan’s network.
- Prescription formulary, drug tiers, prior authorization, step therapy, and quantity limits.
- Monthly premium, medical deductible, drug deductible, copays, coinsurance, and maximum out-of-pocket limit.
- Dental, vision, hearing, transportation, fitness, over-the-counter, or other supplemental benefits.
- Service area, travel needs, and rules for non-emergency care outside the network.
Questions about this information?
Calvin Sulak can help you understand how these general Medicare concepts may relate to your situation and the options available in your area.