 Medicare Advantage plans are health plan options (like HMOs and PPOs) approved by Medicare and run by private companies. These plans are part of the Medicare program and are sometimes called “Part C” or “MA plans,” and they combine the benefits of Medicare Part A and Part B into one benefit. They also serve as an alternative, or replacement, to Original Medicare. Beneficiaries must select to either be covered under original Medicare OR by a Medicare Advantage plan. They cannot have both. Medicare Advantage plans are administered by private health insurance companies that are approved by Medicare. Medicare Advantage plans must follow rules set by Medicare. Currently, nearly a quarter (23%) of Medicare beneficiaries receives their coverage through a Medicare Advantage plan.Medicare Refresher
- Part A
Covers inpatient care (hospital, skilled nursing facility care, home health care, hospice)
- Part B
Covers outpatient care (medical visits, DME, a few prescription drugs)
- Part C
Combines Part A + Part B (previously called Medicare + Choice; now called Medicare Advantage; beneficiaries must still pay their Part B premiums to Medicare)
- Part D
Voluntary prescription drug benefit implemented in 2006
Original Medicare vs. Medicare Advantage
Key Medicare Advantage Dates
- Annual Election Period (November 15-December 31)
- Beneficiaries can change plans, return to Original Medicare, or enroll in a Medicare Advantage plan for the first time
- Change takes effect Jan. 1
- Open Enrollment Period (January 1-March 31)
- Permissible changes include:
- MAPD to a different MAPD
- MAPD to Original Medicare and a PDP
- Original Medicare and a PDP to an MAPD
- MA-only plan to a different MA-only plan
- MA-only plan to Original Medicare
- Original Medicare to an MA-only plan
- Change takes effect following month
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