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Medicare Advantage (Part C) is a popular alternative to Original Medicare (Part A and Part B). When you buy a Medicare Advantage plan, you don’t lose any benefits you’re entitled to under Original Medicare, and in some cases, you may get additional coverage to help lower your out-of-pocket health care costs. Here’s what you should know to compare Medicare Advantage plans.
There are several types of Medicare Advantage plans:
Health maintenance organizations (HMOs): When you compare Medicare Advantage plans, you may find HMOs are the only type of plan available in your area. HMOs usually require you to choose a primary care provider to oversee your medical care, and you must get all your non-emergency care from providers within the plan’s network in order to be covered.
Preferred provider organizations (PPOs*): Medicare Advantage PPOs on the other hand let you see any doctor who accepts your plan, but you pay less out of pocket when you use network providers. Most HMOs and PPOs include Medicare Part D coverage for prescription drugs.
Private fee-for-service plans (PFFS): Medicare Advantage PFFS plans are less common. These plans also let you use any provider willing to accept the terms of your plan, but not every provider who accepts Medicare accepts PFFS plans.
Special Needs Plans (SNPs): Special Needs Plans are only available to individuals who meet certain conditions, such as having a serious or chronic health condition, qualifying for both Medicare and Medicaid, or living in a nursing home or other facility.
Because Medicare Advantage plans are offered by private insurance companies, not all plan types may be available in all areas.
By federal law, all Medicare Advantage plans must provide, at a minimum, the same benefits as Original Medicare. You don’t lose any coverage when you choose Medicare Advantage.
However, some plans offer additional benefits that may make them more attractive, depending on your health care needs. For example, many plans include coverage for routine vision, dental, and hearing care; some even pay some of the costs associated with fillings, extractions, root canals, and dentures. You may even find a plan that covers the Silver Sneakers gym membership and exercise program. If you belong to Silver Sneakers, you may be able to use the facilities at any participating gym or health club for free. You may also be able to take free exercise classes.
If your plan includes Part D prescription drug coverage, you may get discounts on over-the-counter medications and health care supplies.
You may have some or all of the following costs with your Medicare Advantage plan:
You may be able to buy a Medicare Advantage plan with a premium as low as $0 in your area, but keep in mind, you still have to pay your normal Part B premium when you have Medicare Advantage. Any monthly premium required by your plan is in addition to the Medicare Part B premium.
Some Medicare Advantage plans have an annual deductible, although not all do. Generally, there is only one medical deductible with Medicare Advantage compared to both Part A and Part B deductibles with Original Medicare. You may also have a prescription drug deductible.
Most Medicare Advantage plans use a copayment cost-sharing structure, which means you pay a flat fee each time you get health care. You may pay $15 for a primary care visit, for example, and $50 for a trip to the emergency room or urgent care center.
By law, every Medicare Advantage plan has a maximum out-of-pocket spending limit set by the federal government. Once you reach the annual out-of-pocket maximum on covered, in-network expenses (if your plan uses a network), you generally pay nothing for your covered health-care costs for the rest of the year.
It’s difficult to say what each Medicare Advantage will actually cost out-of-pocket until you know what care and services you will receive. A zero-premium plan may sound like the cheapest option, but these plans tend to have higher copayments, deductibles, and out-of-pocket limits than plans that charge a monthly premium. To compare Medicare Advantage plans, you must consider all the costs.
For example, a Medicare Advantage plan with a $0 premium and a $6,700 out-of-pocket maximum spending limit might actually cost you more than a plan costing $200 a month with a $3,000 out-of-pocket maximum, especially if you have a health condition that requires a lot of medical care. The premium doesn’t count toward the out-of-pocket maximum limit.
If you wear eyeglasses or contact lenses, or get regular routine dental care, those optional benefits also offset the overall cost of your Medicare Advantage plan.
Do you want to search for Medicare Advantage plans in your area? Just enter your zip code on this page to begin to compare Medicare Advantage plans.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether the plan will cover an out-of-network service, you or your provider are encouraged to ask for a pre-service organization determination before you receive the service. Please call the plan’s customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.