The Medicare Advantage Plan, also known as Medicare Part C, is a private insurance alternative to Original Medicare, providing coverage through approved private companies. It encompasses various plan types, including HMOs and PPOs, offering Medicare Part A and B services along with potential additional benefits, while requiring a monthly premium for Medicare Part B. Patients can join, switch, or drop these plans during specified enrollment periods, but must be aware of regulations regarding employer coverage and specific conditions like end-stage renal disease.

1. Medicare Advantage
Plan Details
WWW.MEDICARESOLUTIONS.COM

2. What Is the Medicare Advantage Plan?
•An additional health plan for those
eligible for Original Medicare
•Also known as Medicare Part C or MA
Plan
•Theses plans do not offer
supplemental coverage, such as
Medigap insurance

3. What Is the Medicare Advantage Plan?
•The Medicare Advantage Plan is offered
by private companies that are approved
by Medicare
•It is a private insurance alternative to
Original Medicare
•It is necessary to pay monthly part B
premium, as patients are still deemed
to be in the Medicare program

4. The 4 Types of Medicare Advantage Plans
Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Special Needs Plans (SNP)

5. What Is Covered?
•Patient receives Medicare Part A (hospital insurance) and Medicare Part B
(medical insurance) coverage from Medicare Advantage Plan, NOT Original
Medicare
•Hospice care is provided by Original Medicare, NOT the Medicare Advantage
Plan
•Extra coverage such as hearing, vision, and dental may be available

6. What Is Covered?
•Most plans are Managed Care Plans using a
HMO or PPO
•Patient may be required to choose a primary
care physician (PCP) and get a referral to see a
specialist
•Patients may only be allowed to use approved
facilities, hospitals, and physicians

7. How Much Does It Cost?
•The cost of the Medicare Advantage Plan depends on a number of factors such
as the type of services that are needed and the frequency of the treatment
•Patients pay for Medicare monthly, and the Advantage Plan is responsible for
paying the providers of care
•Average monthly premium is $32.59 in 2012, according to U.S. Department of
Health and Human Services

8. How Much Does It Cost?
•A premium and out-of-pocket
expenses can be charged
•Patient must also pay monthly
premium for Medicare Part B from
Social Security check
•Extra premiums possible for additional
services and prescription drugs

9. How Much Does It Cost?
•Patients are sent an Evidence of
Coverage (EOC) and Annual Notice of
Change (ANC) by plan
•EOC provides details of what is
covered by the plan
•ANC has details of forthcoming
changes to costs, coverage, or service
area

10. How to Join
•Medicare Part A and B required; patient must also live in an area where an
existing Advantage Plan accepts new members
•Certain plans only cover specific counties within a state
•Advantage Plans should never ask for financial information over the phone
•Patients are advised to compare plans in their area before choosing

11. Joining, Switching, and
Dropping Medicare Advantage Plans
•When patients join a new Medicare
Advantage Plan, they are automatically
disenrolled from their old plan
•Patients must call 1-844-839-0813 or
contact their current plan to switch
back to Original Medicare
•Patients may only be allowed to switch
at certain times of the year

12. Joining, Switching, and
Dropping Medicare Advantage Plans
•Patients are allowed to join the Medicare
Advantage Plan from three months before to
three months after their 65th birthday
•Those with Social Security Disability Insurance can
join three months before to three months after
their 25th month of disability
•Switching and dropping of plans is allowed during
enrollment period: Nov. 15-Dec.31 annually

13. What If the Plan Stops
Participating in Medicare?
•A plan can decide to leave Medicare at the end of
each year
•A plan will get returned to the Original Medicare if
another Medicare Advantage Plan is not chosen
•A patient has the right to purchase supplement
insurance called Medigap
•Patients are still in Medicare program and will receive
all Medicare-covered services no matter which option
is chosen

14. Prescription Drug Coverage
•Many Medicare Advantage Plans include the Medicare
Prescription Drug Plan (Part D)
•Patients that disenroll from the Advantage Plan and go
back to Original Medicare need to join a Part D program
for coverage
•Patients in an Advantage Plan with Part D coverage that
join a Medicare Prescription Drug Service will be
automatically disenrolled and sent back to an Original
Medicare program

15. Patients With Other Coverage
•Talk to your employer, union, or benefits
administrator to learn about their rules before
considering a Medicare Advantage Plan
•It is possible to lose union or employer coverage by
joining an Advantage Plan
•This may also result in loss of coverage for a
patient’s spouse and dependents
•Those who drop their union/employer coverage
may not be allowed to get it back

16. End Stage Renal Disease (ESRD)
Patients with ESRD are only allowed to join a Medicare Advantage
Plan in certain situations:
•If the ESRD occurred when the patient was already
in the plan
•If the patient is getting health benefits from the
same organization offering the plan
•If the patient had a successful kidney transplant
and qualifies for Medicare benefits

17. Important Considerations
•If a patient is in an Advantage Plan HMO, they
must choose a PCP and only use network
services
•It is not necessary to purchase Medigap if the
patient is already enrolled in a Medicare
Advantage Plan
•It is illegal for anyone to sell a Medigap policy
to someone already on an Advantage Plan

18. Important Considerations
•There is an annual limit on out-of-pocket costs
for medical services
•Medicare Advantage Plans are not allowed to
charge more than Original Medicare for
services like dialysis, chemotherapy, and skilled
nurse facility care
•It is possible to join a plan with any pre-existing
condition except for ESRD, in most
cases

19. Information
Citations
http://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-
plans/types-of-medicare-advantage-plans.html
http://medicare.com/medicare-advantage-part-c/about-medicare-advantage-part-c/
medicare-advantage-plans
http://www.webmd.com/health-insurance/insurance-basics/medicare-advantage-private-
health-insurance-through-medicare
http://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-
plans/things-to-know-medicare-advantage-plans.html
http://www.medicare.gov/your-medicare-costs/medicare-health-plan-costs/costs-for-medicare-
advantage-plans.html
http://www.medicare.gov/sign-up-change-plans/get-drug-coverage/get-drug-coverage.
html