Medicare Advantage (also known as Part C) allows older adults to get their Medicare benefits through private plans. In other words, if you have Medicare Advantage, you still have Medicare; you just receive your Part A and Part B coverage a different way.

There are many different types of Medicare Advantage plans, and each functions in a unique way. These plans include:

• Health maintenance organizations (HMOs)
• Preferred provider organizations (PPOs)
• Special needs plans (SNPs)
• Private fee-for-service (PFFS) plans
• Medicare Savings Accounts (MSAs)

Not all types of Medicare Advantage plans are available in all areas or to all Medicare enrollees. It’s also important to note that a person with Medicare Advantage cannot also have a Medigap (supplemental insurance) policy.

Why choose Medicare Advantage?

Medicare Advantage plans must cover all the same services covered under original Medicare—such as hospital stays, short-term nursing home stays, doctor visits, and diagnostic and laboratory tests.

However, Medicare Advantage plans may also offer additional benefits that original Medicare does not provide. These include:

• Vision / eyeglasses
• Hearing / hearing aids
• Dental services
• Health club memberships
• Medically necessary transportation

Also, these plans may provide non-medical benefits like special debit cards for groceries, help with utility bills, and credits toward purchasing over-the-counter health items.

How much does Medicare Advantage cost per month?

People who enroll in Medicare Advantage plans still pay their monthly Part B premium. They also may pay an additional monthly premium on top of the Part B premium and, for some services, a deductible and a portion of the cost of the services received. The extra premium helps pay for the extra benefits some Medicare Advantage plans offer their members.

How the costs are structured varies by the type of Medicare Advantage plan. People who choose to get their Medicare through a Medicare Advantage plan may be able to receive help paying for their coverage if they qualify for programs such as Medicaid, or Medicare Savings Programs.

What does Medicare Advantage cover for older adults?

With original Medicare, you can go to any doctor, hospital, or other health-care provider that accepts Medicare. But when you join a Medicare Advantage plan, you must follow the rules of the plan to get your coverage.

For instance, some Medicare Advantage plans require you to stay within a network of providers (with which the plan has a contract). Certain plans won't cover you if you go to a doctor's office or a hospital outside of this network. Other plans might cover people you if you go outside the network of providers, but they may require you to pay more money out of pocket.

Some Medicare Advantage plans also offer Part D prescription drug coverage. Others are “stand-alone” plans that only offer health coverage, and you have the option of buying a separate Part D drug plan to cover your medications.

How do I enroll in Medicare Advantage?

There are limited times of the year during which you can enroll (and disenroll) from a private Medicare Advantage health plan. When you're joining Medicare for the first time, you have an Initial Enrollment Period (IEP) during which you can select a Medicare Advantage plan. You can also join, switch, or disenroll from a Medicare Advantage plan during the annual Open Enrollment Period from Oct. 15 to Dec. 7.

The Medicare Advantage Open Enrollment Period (Jan. 1 - March 31) allows anyone with a Medicare Advantage plan at the beginning of the year to switch plans or disenroll from Medicare Advantage and return to original Medicare. There are also Special Enrollment Periods for certain circumstances, such as when you move from one plan’s service area to a new location.

Get help understanding your Medicare Advantage options

There are many factors to explore if you’re thinking about enrolling in a Medicare Advantage plan. If you have questions, consider talking to an experienced Medicare broker that meets NCOA’s Standards of Excellence. They’re on hand to provide easy-to-follow, personalized advice without pressuring you into buying a specific plan. Talk to one of our partners today.

You can also contact the local office of your State Health Insurance Assistance Program (SHIP) by calling 1-877-839-2675. SHIPS offer no-cost, unbiased insurance counseling to older adults, their families, and caregivers. You can make an appointment with your local SHIP office to go over coverage options, which should take about 30-40 minutes and could make a huge difference.