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Medicare Part C: Medicare Advantage

Medicare Part C plans are usually referred to as “Medicare Advantage” plans. All Medicare Advantage plans are run by private companies, and they all combine coverage for hospital stays with coverage for doctor visits. You can choose a plan that includes prescription drug coverage, often at no additional premium, or you can choose a plan without prescription drug coverage.

Medicare Part C Takeaway Information:

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  • What is covered?
  • What is not covered?
  • What are the coverage limits?
  • What providers can I see?

Services Covered

  • Hospital stays
  • Skilled nursing
  • Home health care
  • All the benefits of Part A, except hospice care
  • Doctor’s visits
  • Outpatient care
  • Screenings and shots
  • Lab tests
  • All the benefits of Part B
  • Prescription drug coverage is included in many Medicare Advantage plans, but not all.
  • Eye care
  • Hearing care
  • Wellness services
  • Nurse helpline
  • Extras may be bundled with the plan.

Services Not Covered

Medicare Advantage plans must cover the same services as Medicare Parts A and B, except they don’t provide hospice care, which is still covered by Original Medicare. You can keep your Medicare Advantage plan and receive hospice at the same time. Your Medicare Advantage plan covers your health benefits not related to your hospice care. Look at the plan details to see what other exclusions from coverage it might have. Plans that include drug coverage may have restrictions related to that coverage.

Limits

The terms of these plans vary. Look at the plan details to see limits or exclusions it might have.

Providers

The terms of these plans vary. In some plans, your health care is “coordinated.” That means the plan coordinates your coverage through a primary care physician who manages the care you receive from specialists and hospitals. You may have to choose specific doctors and hospitals. In other plans, you can get care from any Medicare eligible provider who accepts the terms, conditions and payment rates of the plan before providing coverage. Doctors and hospitals can decide whether or not to accept those terms, conditions and payment rates each time they furnish covered services. All Medicare Advantage plans have “service areas.” These are areas, typically a county, state or region, where they offer coverage. Generally, you must live in a plan’s service area in order to join it. However, all Medicare Advantage plans must offer nationwide coverage for emergency care, urgent care (care provided outside a doctor’s office or emergency room for conditions that require immediate attention) and renal dialysis.

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Medicare Advantage

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