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Medicare Advantage (Part C): How It Works

By Nadia-Elysse Harris
Find out what Medicare Advantage Part C plans are, how to enroll, and what benefits you can expect.

Medicare Advantage plans have recently become one of the more popular options among Medicare beneficiaries, accounting for about one third of Medicare coverage in 2019. Over the last ten years, the number of Medicare Advantage beneficiaries has nearly doubled. But what makes Medicare Advantage so appealing and, more importantly, should you take the leap?

What is Medicare Advantage? 

Medicare Advantage, or Medicare Part C, is a type of Medicare plan that uses private health insurance to cover all the services you’d receive under Medicare Parts A and B. Anyone who is eligible for original Medicare Parts A and B is eligible for the Medicare Advantage programs in their area. 

People who choose Medicare Advantage plans may enjoy…

  • One stop shopping: Dental care, prescription drugs, vision care, and other important benefits may all be included in your Medicare Advantage Plan. 

  • Potential savings: Medicare Advantage Plans have out-of-pocket limits on costs associated with your care, while original Medicare does not. 

  • Long-term care services: While original Medicare doesn’t cover long-term care like meal delivery and specialized home care, many Medicare Advantage plans do. 

There are four main types of Medicare Advantage plans, which you can choose based on your needs: Health Maintenance Organization Plans (HMO), Preferred Provider Organization Plans (PPO), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNPs). Home Point of Service Plans (HMOPOS), and Medicare Medical Savings Account Plans (MSA) are also less-common types of Medicare Advantage plans. 

Though often confused with Medicare Supplement (“Medigap”) plans, Medicare Advantage plans are run by private insurers and function like traditional health insurance. You cannot have both Medigap and Medicare Advantage at the same time, so it’s up to you to figure out which type of plan works best for your needs. 

Medigap plans don’t replace your original Medicare plan; they supplement your Medicare coverage with benefits not provided under original Medicare. Medicare Advantage, on the other hand, serves in place of original Medicare. Both Medigap and Medicare Advantage serve as solutions that fill in the “gaps,” if you will, in original Medicare coverage.

What benefits can I expect on Medicare Advantage?

Medicare Advantage covers everything that original Medicare covers. However, Advantage plans also cover hearing, vision, and dental carewhich aren’t covered under original Medicare. Depending on the plan, Medicare Advantage may also cover things like gym memberships, transportation, and adult day-care. 

New to Medicare Advantage plans in 2020, non-medical needs like meal delivery, home air cleaners, and home modifications are now covered by many plans. 

How do I enroll in a Medicare Advantage Plan?

Even if you’re happy with your current health care coverage, you should review your plan during open enrollment to see if you’re overpaying or if your benefits will be changing in the coming year. You can join online, call your preferred Medicare Advantage provider for information about joining, or visit your local Social Security office for in-person support while choosing a plan.

As for timing, here’s when you can enroll...

  • Initial Enrollment Period: With a few exceptions, most people have a 7-month open enrollment period surrounding their 65th birthday to join Medicare. You can join three months before your 65th birthday, during the month of your 65th birthday, or three months after.

  • Fall Open Enrollment: Fall open enrollment for Medicare coverage runs from October 15 to December 7. Any plans you choose during that time will go into effect on January 1. 

  • Medicare Advantage Open Enrollment: From January 1 to March 31, you can switch Medicare Advantage Plans, move back to original Medicare, sign up for Medicare Part D, or remove Medicare Part D. 

  • Special Enrollment Period: This enrollment period is triggered by a change in circumstance and differs based on your personal situation. 

Get started now. 

Interested in learning more about Medicare Advantage plans? WebMD Connect to Care Advisors may be able to help.