Medicare Advantage, also known as Medicare Part C, is an all-in-one alternative to original Medicare.
Private insurance companies offer Medicare Advantage plans that Medicare approves. They bundle Part A hospital coverage and Part B doctor and outpatient services and usually Part D prescription coverage into one comprehensive plan.
In 2023, more than half (51 percent) of Medicare beneficiaries chose to get their coverage through a Medicare Advantage plan, rather than original Medicare, according to KFF, formerly the Kaiser Family Foundation.
If you decide to get coverage through a Medicare Advantage plan, you’ll still have to enroll in Medicare Parts A and B. Then you can choose a Medicare Advantage plan and sign up with a private insurer.
You may have several options, depending on your location. The average Medicare beneficiary has 43 Medicare Advantage plans to choose from in 2024, according to KFF.
What do Medicare Advantage plans cover?
The federal government requires Medicare Advantage plans to cover everything that Medicare Parts A and B cover, but they may have different deductibles and copayments. Most Medicare Advantage plans cover prescription drugs, too. Many plans help pay for services that original Medicare does not cover, such as routine dental, hearing and vision care.
Some Medicare Advantage plans provide additional coverage to people with chronic conditions. Provisions include meal delivery or grocery allowance, shower grips and wheelchair ramps for your home, plus transportation to and from doctors’ offices.
Unlike original Medicare, which covers any provider who accepts Medicare, most Medicare Advantage plans have a provider network and may charge more, or they may not cover doctors or facilities outside the plan’s network.
The two most common types of Medicare Advantage plans are health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
- HMOs typically let you choose a primary care doctor to direct your care; you may need a referral from that doctor to see a specialist. You usually don’t have coverage for out-of-network providers except in emergencies.
- PPOs also have a network of doctors and facilities, but you usually don’t need a referral to see a specialist. You may have coverage if you go outside the plan’s network, but you’ll usually have higher copayments and other out-of-pocket costs.