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How do Medicare Advantage Plans Work

How do Medicare Advantage Plans work?

Here's a quick overview of Medicare Advantage Plans and how they work.

The basics of Medicare Advantage Plans

Medicare Advantage Plans are private health plans. The insurance and health care companies that offer them are contracted by the federal government to provide Medicare benefits.

Medicare Advantage plans sometimes have other names such as Medicare Part C or MA Plans. In a Medicare Advantage Plan:

  • The private insurance plan covers the same service equal to or greater than Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). But, private companies administer the plans instead of the federal government.
  • When compared to Original Medicare (Medicare Parts A and B), benefits and services must be the same or better. One example of coverage difference can be found with hospice care. Some plans may offer additional benefits beyond what is required by the federal government.
  • Generally, companies that offer Medicare Advantage Plans must also offer at least one option that includes Medicare Part D (prescription drug plan) coverage.
  • When a Medicare Advantage Plan also includes Medicare Part D, the plan is called a Medicare Advantage Prescription Drug Plan or a MA-PD Plan.

How do Medicare Advantage Plans work for those who join?

When people enroll in Medicare, they tell the Social Security Administration that they are choosing a Medicare Advantage Plan instead of Original Medicare. Once they have joined the Medicare Advantage Plan, nearly all health services are handled by this private plan. The Medicare Advantage Plan pays its portion of the bills for doctors and hospitals. Depending on the type of health care service they receive, Medicare Advantage enrollees may or may not pay copayments or deductibles. The amount paid can vary from one plan to another.

Like group health insurance, each year Medicare eligibles have an open enrollment period, and can choose to join a plan.

Choices typically include a Medicare Advantage Plan HMO (Health Maintenance Organization) ,a Medicare Advantage Plan PPO (Preferred Provider Organization), Private Fee-for Service (PFFS) Plans, and Special Needs Plans(SNPs).

There are a few other types of private Medicare Advantage plans, too. You can learn more about these in the U.S. government's Medicare & You handbook.

Some people pay a monthly premium to be a member of a private Medicare Advantage Plan, while others do not. The amount of the monthly premium can be different in every county within each state. The premium is paid directly to the private insurance company that offers the plan.

  • If prescription drug coverage is included, could pay a monthly premium
  • Depending on your specific plan, there might also be co-pays, deductibles, and other out-of-pocket costs.

Whether the choice is Original Medicare or a Medicare Advantage Plan, nearly everyone enrolled must also pay a monthly premium for Medicare Part B.

Learn more

If you're interested in learning more about Medicare Advantage Plans, you can Learn which Empire plans are available in your area and compare your options.


Y0071_14_18417_U CMS Accepted 10/09/2013
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Empire BlueCross BlueShield is an HMO Health plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield depends on contract renewal. Empire BlueCross is an HMO plan with a Medicare contract. Enrollment in Empire BlueCross depends on contract renewal.
Services provided by Empire HealthChoice HMO, Inc. licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Empire BlueCross BlueShield is an LPPO plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield depends on contract renewal. Empire BlueCross is an LPPO plan with a Medicare contract. Enrollment in Empire BlueCross depends on contract renewal.
Services provided by Empire HealthChoice Assurance, Inc. licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

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