How do Medicare Advantage Plans work?

A Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by Medicare-approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.

These "bundled" plans include

Medicare Part A (Hospital Insurance)

and

Medicare Part B (Medical Insurance)

, and usually Medicare drug coverage (Part D).

Find Medicare Advantage Plans in your area.

Covered services in Medicare Advantage Plans

With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn't cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine check ups or cleanings). Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness. Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees. These packages will provide benefits customized to treat specific conditions. Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations. Learn more about what Medicare Advantage Plans cover.

Rules for Medicare Advantage Plans

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

Each Medicare Advantage Plan can charge different

out-of-pocket costs

. They can also have different rules for how you get services, like:

Whether you need a referral to see a specialist
If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care

These rules can change each year.

Costs for Medicare Advantage Plans

What you pay in a Medicare Advantage Plan depends on several factors. In most cases, you’ll need to use health care providers who participate in the plan’s network. Some plans won’t cover services from providers outside the plan’s network and service area.

Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for all Part A and Part B services. Once you reach this limit, you’ll pay nothing for services Part A and Part B cover.

Learn about these factors and how to get cost details.

Drug coverage in Medicare Advantage Plans

Most Medicare Advantage Plans include prescription drug coverage (Part D). You can join a separate Medicare drug plan with certain types of plans that:

Can’t offer drug coverage (like Medicare Medical Savings Account plans)
Choose not to offer drug coverage (like some Private Fee-for-Service plans)

You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:

You’re in a Medicare Advantage HMO or PPO.
You join a separate Medicare drug plan.

Note: If you join an HMO or PPO that doesn't cover drugs, you can't join a separate Medicare drug plan. In this case, either you'll need to use other prescription drug coverage you have (like employer or retiree coverage), or go without drug coverage.

If you decide not to get Medicare drug coverage when you’re first eligible and your other drug coverage isn’t creditable prescription drug coverage, you may have to pay a late enrollment penalty if you join a plan later. Learn more about the Part D late enrollment penalty.

How Medicare Supplement Insurance (Medigap) policies work with Medicare Advantage Plans

You can’t buy (and don't need) Medigap while you’re in a Medicare Advantage Plan. You can’t use Medigap to pay for any costs ( copayments , deductibles , and premiums ) you have under a Medicare Advantage Plan. Learn about your options related to Medigap policies and Medicare Advantage Plans.