Medicare Advantage

What Is Medicare Advantage?

While most people on Medicare are covered under Part A and/or B (the “Original Medicare Plan”), some beneficiaries choose Medicare Advantage plans instead. Medicare Advantage plans are private health insurance plans that are a part of the Medicare program. Members receive their health care services through the private plan, and Medicare pays the plan a set amount of money each month for each member’s care, regardless of whether or not the member actually uses any health care services. Members enjoy extra benefits and lower out-of-pocket costs than they would if they were in the Original Medicare Plan, but they must see doctors and use hospitals that belong to the plan. People who are familiar with HMOs or managed care health plans in the private sector will notice that Medicare Advantage plans work the same way.

Who Is Eligible for Medicare Advantage?

People who have Medicare Parts A & B are eligible for Medicare Advantage if they live in a region where Medicare Advantage is available. Unfortunately, plans are not available in every part of the country. Medicare is working to improve access to Medicare Advantage plans for people living in rural areas. To find out if you can sign up for a Medicare Advantage plan, visit Medicare or call 1-800-MEDICARE.

What Do Medicare Advantage Plans Cover?

Because Medicare Advantage plans are private insurance plans, they come in all shapes and sizes. Some will pay for all or part of your Medicare Part B premium. Most offer prescription drug coverage, and many offer extra benefits that are not covered under Parts A & B.   

Important Notice for Current Medicare Advantage Enrollees

If you are currently covered on a Medicare Advantage plan, you will receive a notice from your plan soon that explains your options for Medicare prescription drug coverage in 2006. In many cases, you will be able to remain on your current Medicare Advantage plan without making any changes. However, you are not required to accept Medicare prescription drug coverage if you do not want it - you will also have the option of choosing a different Medicare Advantage plan without prescription drug coverage, or you can return to the Original Medicare Plan.