One third of Medicare beneficiaries choose to get their benefits from a Medicare Advantage (MA) Plan, sometimes called a Medicare private health plan. MA plans contract with the federal government and are paid a fixed amount per person to provide Medicare benefits.
MA plan enrollees still pay a monthly Part B premium (and Part A premium, if applicable). Most MA plans also have an additional monthly premium. If you join an MA plan, you will continue to have Medicare rights and protections.
MA plans must cover all of the services Original Medicare covers except hospice care, which is still covered by Original Medicare. In all types of MA plans, you are always covered for emergency and urgently needed care.
Unlike Original Medicare, all MA plans must include a limit on out-of-pocket expenses for Part A and B services. MA plans often also provide additional benefits that Original Medicare does not cover, such as routine vision, hearing and eye wear coverage.
You can join a Medicare Advantage Plan if:
1. You have Medicare Parts A and B;
2. You live in the plan’s service area; and
3. You do not have End-Stage Renal Disease (ESRD) – are not on kidney dialysis or waiting for a kidney transplant.
Ten things to know about Medicare Advantage (MA) Plans
1. You are still in the Medicare Program.
2. You can join a Medicare Advantage plan if you are enrolled in both Medicare Parts A & B.
3. You still have Medicare rights and protections.
4. You still get complete Part A and Part B coverage through the plan.
5. You have worldwide coverage for Emergency and Urgent Care.
6. You can only join a Medicare Advantage plan at certain times during the year.
7. You can join a Medicare Advantage Plan even if you have a pre-existing condition, except for End-Stage Renal Disease (ESRD).
8. You can check with the plan before you get a service to find out if it's covered and what your costs may be.
9. Medicare Advantage plans can't charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
10. Unlike Traditional Medicare, all Medicare Advantage plans have a yearly limit on out-of-pocket costs for medical services. Once you reach this limit, you’ll pay nothing for covered services.
This webpage was updated on October 1, 2019.