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Medicare Insurance

What is Medicare Advantage?

Medicare Advantage plans (Medicare Part C) are a form of private health insurance that provides the same coverage as Medicare Part A and Part B (Original Medicare) and may include additional benefits such as dental, vision, and prescription drug coverage.

All of the available plan options are designed to help cover some of the expenses not paid by original Medicare and help limit your annual spending for medical care and prescription drugs. Original Medicare alone has substantial deductibles and copayments, and you can easily spend thousands of dollars each year for out-of-pocket medical expenses.

Medicare Advantage Insurance

What does Medicare Part C cover?

All Medicare Advantage plans include the same standard benefits as Original Medicare. Most Medicare Advantage plans also provide prescription drug coverage. Some Part C plans may also cover benefits such as:
  • Routine dental and vision care
  • Hearing care and allowances for hearing aids
  • Health and wellness club memberships, such as SilverSneakers
Some Medicare Advantage plans may also cover services such as non-emergency medical transportation, home health care and home modifications such as bathroom grab bars. Some types of plans restrict your coverage to in-network health care providers.

Medicare Advantage Insurance

How much does Medicare Part C cost?

If you enroll in a Medicare Advantage plan, you may have to pay some or all of the following expenses:

  • Original Medicare premiums

  • Medicare Advantage plan premiums

  • Out-of-pocket costs such as copayments, coinsurance, and deductibles

Some Medicare Advantage plans feature $0 premiums, though $0 premium plans aren’t available in all locations.

In 2021, 54 percent of all Medicare Advantage plans that include prescription drug coverage feature a $0 premium, and 96 percent of Medicare Advantage beneficiaries who have a plan that includes drug coverage are enrolled in a $0 premium plan.1

Medicare Advantage Insurance

Who is eligible for Medicare Advantage plans?

There are 3 general eligibility requirements to qualify for Medicare Part C:
  • You must be enrolled in Original Medicare (Part A and Part B)
  • There must be a Medicare Advantage plan offered in your area
  • You do not have End-Stage Renal Disease (ESRD)
You enroll in a Medicare Advantage plan through a private insurance company, not the government. You must be enrolled in Original Medicare before you can enroll in a Medicare Advantage plan. You cannot have a Medicare Advantage plan and a Medicare Supplement insurance policy at the same time. If your Medicare Advantage plan does not include prescription drug coverage, you may be allowed to add a Medicare Part D plan as well. Medicare requires that you enroll in, disenroll from, or make changes to your Medicare Advantage plan only during pre-determined enrollment periods.