Medicare Advantage Plans

  • Offered by private insurance companies, Medicare Advantage plans replace Original Medicare coverage. They often provide broader coverage but limit the range of doctors and providers your loved one can use.
  • A Medicare Advantage plan may cover prescription drugs, so your loved one may not need Prescription Drug Plans (Part D).
  • Claims must be submitted to and paid by the health insurance company--not the federal government.

Compare Medicare Plans

Investigate the different plans available by using Medicare’s plan comparison tool.

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Medicare Advantage plans, offered by private health insurance companies, replace Original Medicare coverage. These plans combine all the core Medicare benefits with certain additional benefits into one combined plan. In many cases, prescription medications are also covered, making it unnecessary to purchase Prescription Drug Plans (Part D).

Incompatible With Medigap

In some states, Medicaid goes by a different name. For information on your state’s Medicaid program, contact your state’s Department of Social Services.

To be eligible for a Medicare Advantage plan, your loved one must live within its service area and be covered by Original Medicare (if your loved one moves, he or she will likely need to change plans). By law, Medicare Advantage plans must cover at least the same fees and services as Original Medicare. In fact, a person with Medicare Advantage coverage remains enrolled in Medicare and retains the same rights and protections.

Are there different types of Medicare Advantage plans?

Several types of plans are available, each with different benefits, provider choices, and cost-sharing rules. Your loved one will still need to pay the Part B premium and may have to pay an additional premium. Medicare Advantage plans include:

Medicare Managed Care Plans

These include plans such as health maintenance organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans sold by private health insurance companies. Generally, they require your loved one to use the plan’s pre-approved facilities and providers within specific locations.

Medicare Private Fee-For-Service Plans

These plans offer a wider range of provider choice than Managed Care plans. The health insurance company pays a specified share of the medical expense; your loved one pays the remainder.

Medicare Medical Savings Account Plans

These plans have two components. The first is a Medicare Advantage health plan with a high deductible. The second is a Medical Savings Account into which Medicare deposits money your loved one can use to pay costs until the deductible is reached. If you don’t spend the money in the account, it rolls over to the next year.

Medicare Special Needs Plans

Available in some parts of the country, Special Needs Plans (SNPs) are designed to help manage and coordinate all the services needed by people who have certain chronic diseases and conditions. They provide all the elements of Original Medicare and Prescription Drug Plans (Part D) with additional benefits and possibly lower copays.

Next Step: Investigate the different plans available by using Medicare’s plan comparison tool. Use Medicare’s tool

Find a Government Agency

  • Select a state to view agencies that may assist with caregiving and eldercare issues.