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Understand Medicare

Medicare Part C: Medicare Advantage Plans

When you choose a private Medicare Advantage plan, you agree to have the private plan administer your Medicare Part A and Medicare Part B benefits. Medicare Advantage plans include both hospital and medical coverage. Many of these plans include Part D prescription drug coverage, giving you the convenience of receiving all your hospital, medical and prescription drug benefits from one plan (more about Part D in the next section).

 

Types of Medicare Advantage Plans

Health Maintenance Organization (HMO)

In Medicare Advantage HMO plans, you generally get your care and services from doctors, hospitals, and other health care providers in the plan’s network (except emergency care, out-of-area urgent care or out-of-area dialysis). In some plans, such as HMO-POS plans, you may be able to go out-of-network but you usually pay higher cost sharing.

Preferred Provider Organization (PPO)

With a Medicare Advantage PPO plan, you pay less if you use doctors, hospitals and other health care providers within the plan network. Usually, you have the option to get health care from any doctor, hospital or provider, but you pay more if you go outside the network.

Understanding the Basics

You pay a premium for the Medicare Advantage plan in addition to your Part B premium. The premium may change annually, but it is not tied to your age. Once you have joined a Medicare Advantage plan, you usually cannot change plans until the annual Medicare open enrollment period between October 15 and December 7 (for January 1 effective date).

    You are eligible if you:
  • Are enrolled in Medicare Part A and Medicare Part B
  • Are a permanent resident in the service area of the plan
  • Do not have End-Stage Renal Disease (ESRD)
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Medica is a Cost and HMO-POS plan with a Medicare contract. Enrollment in Medica depends on contract renewal.

Y0088_4948 CMS Pending
Last Updated: October 2017