Medicare Advantage

What is a Medicare Advantage or Medicare Part C Minnesota plan?

Medicare Advantage plans, sometimes called “Part C” or “MA plans,” are an “all in one” alternative to original Medicare. They are offered by private insurance companies approved by Medicare.  If you join a Medicare Advantage plan, you still have Medicare, but the Part C insurance company will be paying most of your claims. These “bundled” plans include  Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare prescription drug (Part D).

Covered services in Medicare Advantage plans

Medicare Advantage plans cover all Medicare services.  Some Medicare Advantage plans also offer extra coverage like vision, hearing and dental coverage.  

Rules for Medicare Advantage plans

Medicare pays a fixed amount for your care each month to the Medicare Advantage company that you choose to enroll in. The company 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.
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 services.
What services need pre-certification.
These rules can change each year.

Drug coverage in Medicare Advantage plans

Most Medicare Advantage plans include prescription drug coverage (Part D).

You will be dis-enrolled from your Medicare Advantage plan and returned to Original Medicare if you’re in a Medicare Advantage HMO or PPO and you join a separate Medicare Prescription Drug plan.

What you pay in a Medicare Advantage plan

Your out-of-pocket costs in a Medicare Advantage plan (Part C) depend on:

Whether the plan charges a monthly premium.
If the plan has a yearly deductible or any additional deductibles.
How much you pay for each visit or service (co-payment or coinsurance). For example, the plan may charge a co-payment like $10 or $20 every time you see a doctor. These amounts can be different than those under original Medicare.
Whether you follow the plan’s rules like using network providers.
If you go out of network.
The plan’s yearly limit on your out-of-pocket costs for all medical services.

Get more cost details from your plan

If you’re in a Medicare Advantage plan (Part C), review the notices your plan sends you each fall: “Evidence of Coverage” (EOC). The EOC gives you details about what the plan covers, how much you pay, and more. “Annual Notice of Change” (ANOC). The ANOC includes any changes in coverage, costs, or service area that will be effective in January. If you don’t get these important documents, contact your plan.