Medicare Excellent Program

What are Medicare Advantages?

Medicare Advantage is part of the Medicare program for eligible seniors and people with disabilities. Also known as a Part C plan, the Medicare Advantage (MA) plan is offered by private insurance companies rather than the federal government. They include health coverage provided by the same Part B Original Medicare in hospitals and hospitals, but not end-of-life care. Most M&A plans also include Part D prescription drug coverage. Anyone who joins the MA program gets attention. 1 2

KEY TAKEAWAYS

  • Medicare Advantage, also known as Medicare Part C, is offered to people age 65 and eligible seniors and people with disabilities.
  • Plans are offered by Medicare-approved private insurance companies.
  • Coverage is the same as Part A Hospital, Part B Medicare, and Part D prescription drug coverage, except for hospice.
  • The company receives a fixed monthly fee for plan care and may bill policyholders for out-of-pocket costs. 2

How the Medicare Advantage Works

Medicare is generally available to people age 65 or older, younger people with disabilities, and people with end-stage renal disease and permanent kidney failure who need dialysis or transplants or amyotrophic lateral sclerosis (ALS). 3 4 Medicare Advantage is a Medicare health plan offered by a Medicare-approved private company. They are considered a replacement for the original medical insurance and pay all the costs in the medical insurance. Some Medicare Advantage plans pay for additional costs not covered by Medicare, including vision, dental, and hearing costs. Medicare pays premiums for participants in Medicare Advantage plans. Medicare Advantage does not apply to Medigap, also known as Medicare Supplement. 2

Average monthly premiums for Medicare Advantage plans in 2021 are expected to drop 11% to around $21 from an average of $23.63 in 2020. 5 Private companies receive a fixed monthly amount of Medicare Advantage care. These companies, in turn, can charge out-of-pocket costs and be able to establish their own rules for services, such as referrals for non-urgent care and emergency services or the needs of a provider network.

Regional Preferred Provider Organizations (PPOs) were created to provide rural beneficiaries with additional Medicare Advantage plans with statewide or multistate coverage. Regional PPOs account for 5% of all Medicare Advantage enrollees by 2020. In 2020, approximately 24 million people, or 36 percent, received Medicare benefits and enrolled in Medicare Advantage. That number is expected to climb to more than 26 million in 2021. 6 7

Types of Medicare Advantage Plans

The most common Medicare Advantage plans are Health Maintenance Organization (HMO) plans, which account for the majority of Medicare Advantage enrollments, PPO plans, Private Fees for Services (PFFS) plans, and Special Needs Plans (SNPs). Basic eligibility to enroll in one of these plans includes living in the plan’s service area and having Medicare Parts A and B. HMO Point of Service (HMO-POS) plans and Medical Savings Account (MSA) plans are less common. 2

Starting in 2021, people with the end-stage renal disease will be able to enroll in Medicare Advantage. 4

Medicare Advantage plans are not available for people with end-stage renal disease (ESRD) unless they can find an ESRD special needs plan nearby. But starting in 2021, people with ESRD will be able to enroll in any Medicare Advantage plan in their area. Patients with ESRD should compare the cost of the Medicare Advantage plan to the original Medicare plus Medigap and Part D plans and check to see if their doctor and hospital are connected to any MA plans they are considering. 4

special attention items

The Medicare Online Plan Finder Tool includes information about Medicare Advantage plans. To enroll in the Medicare Advantage plan, consumers must provide the information on their Medicare card, including their Medicare number and the date the application for Part A and Part B coverage began. People can change to Medicare Advantage plans during a specific open enrollment period in the fall (usually from mid-October to early December). 8 9

Like other types of Medicare, each Medicare Advantage plan has different rules regarding treatment coverage, patient liability, cost, and more. Enrolling in a Medicare Advantage plan may make some people ineligible to continue getting Medicare through their employer or union, so they may want to defer enrolling in Medicare if employer-based coverage meets someone’s needs. 10

All Medicare Advantage plans have an annual limit on out-of-pocket costs, which may make them more cost-effective for some beneficiaries. By 2021, the annual maximum will rise from $6,700 to $7,550, although many plans have lower out-of-pocket caps. 11 Medicare Part B 2021 monthly premiums and annual deductibles are $148.50 and $203, respectively. 

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