Medicare Advantage plans are insurance plans offered by private companies who are approved by Medicare themselves. Medicare Advantage is often referred to as Part C and is not included within Original Medicare, which consists of Parts A and B.

Medicare Advantage: Coverage and costs

All types of Medicare Advantage Plans must cover emergency and urgent care. A  Medicare Advantage Plans will include all of the services provided by Original Medicare with the exception of hospice care and certain clinical research studies. Original Medicare will provide cover for hospice care and some costs for clinical research studies, even in a Medicare Advantage Plan. A great benefit of a Medicare Advantage Plan is that many include cover for additional healthcare requirements, including vision care, hearing and dental. Most Part C plans also include Medicare prescription drug coverage (Part D). As well as paying a premium for Part B of Medicare coverage, there will often be an additional monthly premium for the Medicare Advantage Plan.

Types of Advantage Plan

  • Health Maintenance Organization (HMO) plans: In HMO plans; you can only attend doctors, other health care providers, or hospitals that operate within the plan’s network except in an emergency case.
  • Preferred Provider Organization (PPO) plans: With a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You can use healthcare providers out with the network but you will end up paying more as a result.
  • Special Needs Plans (SNPs): These provide specific and specialist health care services for certain groups of people, for example, those who receive both Medicare and Medicaid, reside in a nursing home, or have certain lifelong conditions.
  • Medical Savings Account (MSA) plans: These plans are a combination of a plan with high deductibles and a bank account to cover any medical costs which may arise. Medicare deposits money into the account and the funds are used to pay for your health care services during the year.