Medicare Part C
Get Local Medigap QuotesCommonly referred to as "Medicare Advantage or MA"
Medicare Advantage must provide the same benefits as Part A and B, except for hospice care, and some services covered by Part A. If you join a Medicare Advantage plan you no longer have access to your original Medicare cost-sharing under Parts A & B, you are now subject to the cost-sharing associated with the Medicare Advantage plan. Many Medicare Advantage plans include Part D, which is prescription drug coverage. These plans include doctor visits, hospital stays, and other health care providers within a defined network with the plans co-payments and deductibles.
Who is eligible for Medicare Advantage Plans
Anyone enrolled in Medicare Part A, Part B, and lives in the service area can enroll. Medicare Advantage plan availability can vary by location and plans aren't available in all areas.
Medicare Advantage Plan Options
Medicare Advantage plans come in a few options. All options are not available in every area. The options excel in different ways. The plan you select determines the costs and coverage type.
Health Maintenance Organization (HMO)
In most HMO plans you must get care from doctors and other health care providers in the defined network, you may only have Emergency Room coverage outside the network. In most cases, you must choose and Primary Care Physician (PCP) and get a referral each time you want to see a specialist.
Note: you technically do have the ability to go to any healthcare provider in the HMO network but your PCP isn’t required to give you a referral to see all the doctors.
Preferred Provider Organization (PPO)
Like HMO Medicare Advantage plans PPO plans also have a defined network of healthcare providers but you can go outside the defined network. In a PPO plan, you typically pay less to use the healthcare providers in the plan's defined network. In most cases, you don’t need a PCP or referrals to see a specialist.
Private Fee-for-service (PFFS)
PFFS plans aren’t the same as Original Medicare or Medigap plans. In some cases, PFFS plans have a defined network but you can choose to go out of the network. You can go to doctors that choose to accept the PFFS plan's terms of service. For each service, you receive it is important to make sure the healthcare provider is going to accept the plan's payment terms.
Important Notes
- Medicare Advantage plans are NOT Original Medicare or the same as a Medigap policy.
- You must continue to pay your Medicare Premium when you are enrolled in a Medicare Advantage plan.
- Healthcare Providers can leave the network at any time and you may lose access to them.
- Medicare Advantage plans can and with change each year so it is important to review your benefits annually.
- You are locked into the Medicare Advantage plan for the entire calendar year unless you qualify for a Special Election Period (SEP) defined by Medicare.
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800 MEDICARE to get information on all of your options.
Not affiliated with the U. S. government or federal Medicare program.
Last updated: 01.05.2023 at 12:01 AM MULTIPLAN_SHDLEAWE001_M.