Medicare Advantage Plans

Medicare Advantage (formerly called Medicare+Choice) offers several health care alternatives to original Medicare. Original Medicare allows you to visit any doctor, hospital, or health provider that accepts Medicare. Medicare pays for many of the health care services and supplies you receive but doesn’t pay for all costs. You may be required to pay for coinsurance, copayments, and deductibles.

Medicare Advantage plans may offer more benefits and have lower out-of-pocket costs. Medicare Advantage plans are available from private companies that contract with the Center for Medicare and Medicaid Services (CMS), the federal agency that administers the Medicare program. The plans have at least the same benefits as Medicare Part A (hospital coverage) and Part B (medical coverage) and often include additional benefits, such as the Medicare prescription drug coverage (Medicare Part D).

To be eligible to join a Medicare Advantage plan, you must live in the plan’s service area, be enrolled in Medicare Part A and Part B, and not have end-stage renal (kidney) disease. You can typically enroll in a Medicare Advantage plan even if you have existing health problems, except for end-stage renal disease. (You can continue in the Medicare Advantage plan if you develop end-stage renal disease while you are in the plan.) Medicare Advantage special needs plans may be an option for some people with chronic health conditions.

If you enroll in a Medicare Advantage plan, you are still part of the Medicare program. Medicare will pay your Medicare Advantage plan a set amount each month. You pay your monthly Medicare Part B premium in addition to any additional premium the Medicare Advantage plan charges.

Each year, Medicare Advantage plans can decide to join or leave Medicare. If your plan leaves Medicare, you will receive prior notice and have several options to obtain Medicare benefits. You may join another Medicare Advantage plan in your area or return to original Medicare. If you return to original Medicare, you have a right to buy a Medicare supplement insurance policy. Medicare supplement insurance, sometimes called Medigap, pays some of the expenses that original Medicare doesn't cover. If you apply within 63 days of the date your Medicare Advantage coverage ends, an insurance company must sell you a Medigap policy regardless of your medical history or pre-existing conditions. This protection is called a “guaranteed issue right.” The departing plan will provide you information about this and other rights and options available.