Medicare Advantage

What's Medicare Advantage?

Sometimes called "Part C" – includes both Part A (Hospital Insurance) and Part B (Medical Insurance) and often, but not always, Part D (prescription drugs).

Who provides coverage? Private insurance companies approved by Medicare.

How do you choose your providers? You may need to use health care providers who participate in the plan’s network.

How much does it cost?
  • In 2020, the standard Part B premium amount is $144.60 (or higher depending on your income).
  • You usually pay a monthly premium for your MA Plan depending the area location (in addition to your monthly Part B premium).
  • You may pay a copayment or coinsurance for covered services. Many MA plans offer extras, such as vision coverage, hearing aid discounts, and limited dental coverage and more. Costs, extra coverage, and rules vary by plan.
  • Plans usually offer a yearly limit on your out-of-pocket costs. Once you reach that amount, you will pay nothing for covered services for the rest of the year (exception is Part D coverage).
  • Your out-of-pocket costs may be lower in an MA plan. This option can sometimes be more cost effective for you.
What you pay for out-of-pocket costs in a Medicare Advantage Plan

Your out-of-pocket costs in a Medicare Advantage Plan (Part C) depend on:

  • Whether the plan charges a monthly premium. Some plans have a zero premium.
  • Whether the plan has a yearly deductible or any additional deductibles.
  • How much you pay for each visit or service (copayment or coinsurance). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.
  • The type of health care services you need and how often you get them.
  • Whether you go to a doctor or supplier who accepts assignment if:
    • You are in a PPO, PFFS, or MSA plan.
    • You go out-of-network.
  • Whether you follow the plan's rules, like using network providers.
  • Whether you need extra benefits and if the plan charges for it.
  • The plan's yearly limit on your out-of-pocket costs for all medical services.

Whether you have Medicaid or get help from your state.