Medicare Advantage (Part C) is an alternative to Original Medicare (Parts A & B) that is offered by private insurers. It must cover everything that Original Medicare covers. Most Medicare Advantage plans offer additional features, such as vision, dental, and prescription drug coverage (Part D).
While Original Medicare is administered by the government, Medicare Advantage is the blanket term for plans that are sold by private insurers.
Medicare Advantage plans are required to cover all of the services that Original Medicare covers, but they often layer on more benefits.
For instance, while Original Medicare might cover only doctor and hospital visits, a Medicare Advantage plan might include vision, hearing, dental, and prescription drugs as well. Some may even include fitness or wellness benefits.
Here are some important differences between Medicare Advantage and Original Medicare:
- Medicare Advantage plans have yearly limits on your out-of-pocket costs.
- Medicare Advantage plans may limit you to using health care providers who are in-network.
- Medicare Advantage plans usually don’t cover care you receive outside of the U.S.
- If you have Original Medicare, you can add a Medicare Supplement (Medigap) plan to help limit your out-of-pocket costs. You cannot, however, have both Medicare Advantage and a Medicare Supplement plan.
Before joining a Medicare Advantage plan, be sure to find out what it covers, along with any estimated costs for services or prescription drugs.
Medicare Advantage plans operate as HMO or PPO networks, meaning you should also check with your primary care physician (PCP) and any specialists you see to find out if they are in your HMO or PPO network before you select a plan. You can learn more at Medicare.gov/find-a-plan.
You’re eligible for Medicare Advantage if you have Original Medicare, you live in the plan’s service area, you don’t have end-stage renal disease (except in certain situations), and you’re a U.S. citizen or lawful permanent resident.