Medicare Advantage (Medicare Part C Coverage) Plans

Medicare is a federal health insurance program designed for seniors aged 65 and older. People with qualifying disabilities may also be eligible for these benefits.

Once you have original Medicare (Part A and Part B), you can opt to join a Medicare Advantage plan (Medicare Part C). Medicare Part C is an alternative to traditional Medicare.

With Medicare Part C, you can choose from numerous private health insurance plans. Different types of Medicare Advantage plans offer somewhat different benefits.

Types of Private Health Plans

Under Medicare Advantage, participants may choose from a number of private health plans, which include the following:

Health maintenance organization (HMO) plans

HMOs require you to go to doctors, other health care providers, or hospitals that are on the plan’s list, except in an emergency. You may also need to get a referral from your primary care doctor to see a specialist.

Preferred provider organizations (PPOs)

PPOs allow the use of doctors and hospitals outside the plan network for an extra out-of-pocket cost.

Private fee-for-service plans (PFFSs)

These are Medicare-approved private health insurance plans for which Medicare pays part of the cost. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Special needs plans (SNPs)

SNPs limit membership to people with specific diseases or characteristics. The plan tailors benefits, provider choices, and drug formularies (the list of drugs it covers) to best meet the specific needs of the groups they serve.

Medical savings account (MSA) plans

With this type of plan, you can join a high-deductible plan and also set up a special medical savings account with a bank that the plan selects.

Medicare then gives the plan an amount of money each year for your health care, and the plan deposits some money into your account. You can use the money in your account to pay your health care costs, including health care costs not covered by Medicare. Money left in your account at the end of the year stays in the account; you can then use it for health care costs in future years.

How Much Does Medicare Part C Cost?

Costs, as well as covered services, can differ widely depending on the Medicare Advantage plan you choose. The average Part C monthly premium in 2024 is $18.50, but can range from $0 a month to more than $100 per month.

Changing Plans

Once you choose a Medicare Advantage plan, you can only change plans during certain times of the year. You can switch plans during the Medicare open enrollment period, which runs annually from October 15 through December 7.

You can also join a Medicare drug plan during that period. From January 1 through March 31, you can switch Medicare Advantage plans. Or, you can go from Medicare Advantage to original Medicare, with or without prescription drug coverage (Part D).

Enrollees who are happy with the way they are receiving Medicare can stay with their program, unless the program stops participating in Medicare. New Medicare enrollees who do not choose a particular program will automatically become enrollees in traditional Medicare.

Medicare is a complex topic. For professional guidance, you may consider visiting Medicare’s Plan Finder, an online tool that helps you to compare plans.

Also available are State Health Insurance Assistance Programs (SHIPs). SHIPS offer you trained counselors who can give you impartial advice; search for your local SHIP online. Or, you also may wish to seek out a qualified elder law attorney in your area.