Medicare Advantage Plans

What Is a Medicare Advantage Plan?

A Medicare Advantage plan (MA) offers the same benefits as traditional Medicare, but it also includes additional coverage and services that are not offered in Original Medicare.

You can choose from one of three types of MA plans: Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), or Private Fee-for Service (PFFS).

Under the Affordable Care Act, you may be able to enroll in an MA plan through your employer if your current health insurance carrier does not offer one. You must have certain income limits to qualify for this option.

If you do not qualify for this option, you will need to decide whether to purchase an individual policy or join a private Medicare Part D prescription drug plan.

How Medicare Advantage plans work

Medicare Advantage plans also known as Medicare Part C are required to provide the same benefits as Medicare Part A , which covers hospitalization, and Medicare Part B , which covers doctor’s visits. Additionally, Medicare Advantage plans usually include Medicare Part D prescription drug coverage, as well as some benefits not covered by Medicare, such as dental care, eye exams, and hearing aids.  


What you pay in a Medicare Advantage Plan

When you enroll in a Medicare Advantage plan (Medicare Part C), you continue to pay premiums for your Medicare Part B (medical insurance) benefits. Medicare decides the Part B premium rate. In 2022, the Part B premium is estimated to be $170.50, but it can be higher if your income is higher. On average, those receiving Social Security benefits will pay a lower premium rate.

Medicare Part C plans usually have a separate monthly premium. However, not all Part C plans have a monthly premium. Part C plans generally cover medically necessary procedures as well as prescription drug coverage (Medicare Part D) and other types of benefits. You may pay a premium to cover the broader range of services offered by Medicare Part C.

Medicare-approved private insurance companies that offer Medicare Part C coverage determine what services the plans will cover. Monthly premiums therefore vary from plan to plan and state to state. Each year, insurance companies are only allowed to change the premium rate.