A Medicare Advantage (MA) plan is a type of health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Parts A and B benefits. MA plans include health maintenance organizations, preferred provider organizations, private fee-for-service plans, and Special Needs Plans.
Advantages of MA plans
- Most MA plans have low monthly premiums. Some may not charge any monthly premium.
- Some plans may provide more benefits than are covered under Original Medicare.
Disadvantages of MA plans
- MA plans are annual contracts. Plans may decide not to negotiate or renew their contracts.
- Plans may change benefits, increase premiums and increase copayments at the start of each year.
- You may have higher annual out-of-pocket expenses than under Original Medicare with a Medicare supplement (Medigap) plan.
- Your current doctors or hospitals may not be network providers or may not agree to accept the plan's payment terms.
- In most cases, you cannot keep your stand-alone Medicare Part D plan and the Medicare Advantage plan.
What are the differences between MA plans and Medigap plans?
Medicare Advantage plans
Are there out-of-pocket costs?
More out-of-pocket costs, but may have lower premiums
Fewer out-of-pocket costs, but may have higher premiums
Where can I use the plan?
Works only in your state, by region or county
Works in any state
Do I have to use the plan's network of providers?
Must use a provider network
No provider network required unless you buy a Medigap Select plan
Does the plan include prescription drug coverage (Part D)?
Most plans cover Medicare Part D
Medicare Part D not included
Things to consider before you buy a plan
Ask your medical providers If they'll take the MA plan.
Ask the plan if It requires a referral for you to see a specialist.
If you live in another state part of the year, find out if the plan will still cover you. Many plans require you to use regular services within the service area (except for emergency care), which is usually the county in the state where you live.
Find out if the plan includes:
- Monthly premiums
- Any copayments for various services
- Any out-of-pocket limits
- Costs to use non-network providers
If you have Medicaid or receive long-term care, or live in a nursing home, Special Needs Plans may be available in your area. If you choose other types of MA plans, find out if:
- The plan's in-network providers you use are certified to accept Medicaid.
- In-network providers bill the plan correctly and/or refer to Medicaid providers as needed.
- The providers' office knows what Medicaid covers and what the plan covers.
- You'll have monthly premiums to pay. Medicaid will not cover MA plan premiums.