Medicare Advantage (Medicare Part C) is a coverage alternative to Original Medicare. Medicare Part C plans are offered by private insurers approved by Medicare. In 1997, Congress passed legislation creating the Medicare+Choice program, which was renamed Medicare Advantage under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. 1
As of September 2023, there were nearly 32.5 million people covered by Medicare Advantage, accounting for almost half of the more than 66 million total Medicare beneficiaries. (The rest had Original Medicare.) 2 Enrollment in these plans has grown significantly over the years. In 2007, only 19% of Medicare beneficiaries had Medicare Advantage plans. 3
All Medicare Advantage plans are required to cover services that are covered by Medicare Part A and Medicare Part B, with the exception of hospice services. However, the out-of-pocket costs for these services vary widely between Original Medicare and Medicare Advantage. And there can be different coverage rules under Medicare Advantage plans, such as a requirement to use in-network medical providers or obtain prior authorization.
This differs from one Medicare Advantage plan to another, and also differs from Original Medicare. Original Medicare allows beneficiaries to use any provider who accepts Medicare, and prior authorization is very rarely used in Original Medicare.
Medicare Advantage enrollees only have one plan, rather than having to use multiple plans to get coverage for all the care they need. (For example, Medigap – also known as Medicare supplement insurance – only works in conjunction with and as an add on to Original Medicare, and cannot be used with Medicare Advantage).
Since 2019, Medicare Advantage plans have been allowed to cover a broader range of extra benefits than they could in prior years 4 and some Medicare Advantage plans have chosen to offer these benefits. As of 2023, 97% of Medicare Advantage plans offer some type of extra benefit not covered by Original Medicare (although, different benefits are available to different enrollees depending on availability and health status. 5
A note about hospice care: In most cases, this is covered under Original Medicare, even if the person is enrolled in a Medicare Advantage plan. 6 But CMS debuted a small pilot program in 2021, under which a limited number of Medicare Advantage plans are providing hospice services through the Medicare Advantage plan rather than through Original Medicare. 7 )
Medicare Open Enrollment – also known as the Annual Election Period – runs from October 15 to December 7 each year. This is an opportunity for Medicare beneficiaries to switch to a different Medicare Advantage plan or enroll in one for the first time. Plan selections made during this window will take effect January 1 of the following year.
In addition, a Medicare Advantage Open Enrollment Period – from January 1 through March 31 – is an opportunity for people already enrolled in Medicare Advantage to switch to another Medicare Advantage plan or to switch to Original Medicare.
The cost of a Medicare Advantage plan varies depending on the plan you select. Medicare Advantage enrollees pay the Medicare Part B premium ($174.70/month for most beneficiaries in 2024), although some Medicare Advantage plans cover a portion of this cost for their enrollees. 8
Across all Medicare Advantage plans, the average premium is about $18.50/month in 2024. 9 in addition to the cost of Medicare Part B. But two-thirds of 2024 Medicare Advantage plans with integrated Medicare Part D prescription drug coverage (MA-PDs) are “zero premium” plans. 10 This means that they don’t charge a monthly premium and enrollees only have to pay the premium for Medicare Part B.
Average MA-PD premiums tend to be lower for HMOs versus PPOs. In 2023, KFF reported that the average HMO MA-PD had a premium of $14/month, whereas the average local PPO had a premium of $17/month and the average regional PPO had a premium of $46/month. 11
The majority (56%) of 2024 Medicare Advantage plans are HMOs, although this is down from 71% in 2017. Local PPOs account for 42% of plans in 2024, up from 24% in 2017. Regional PPOs are rare, accounting for just 1% of plans in 2024. 12
If you already have Medicare Part A and Medicare Part B (or are eligible to enroll in th97em), you can choose to enroll in any Medicare Advantage plan available in your area, instead of Original Medicare. You can do this when you’re first eligible for Medicare, or during Medicare Open Enrollment (the Annual Election Period).
But there are some rural areas of the country where no Medicare Advantage plans are available for purchase. 5 If you’re in one of those areas, Original Medicare is your only Medicare coverage option.
An increasing number of employers are using Medicare Advantage plans to provide health coverage to their retirees: About 18% of Medicare Advantage enrollees are enrolled in employer-sponsored Medicare Advantage plans. 13
If you have employer-sponsored or union-sponsored health benefits, you may be able to add a Medicare Advantage plan, but you’ll want to discuss this with your benefits administrator first, to ensure that you won’t lose your existing health benefits if you enroll in a Medicare Advantage plan.
Special Needs Plans (SNPs) are Medicare Advantage plans that are specifically designed to cater to the needs of certain populations, such as individuals with certain chronic medical conditions. Institutional Special Needs Plans (I-SNPs) are for, among other things, people who live in long-term care skilled nursing facilities. In order to join any SNP, you would have to meet the specific eligibility requirements of the plan. 14
There are five different types of Medicare Advantage plans 15 although not all of them are available in all areas:
A few points to know about the different coverage types:
Yes, zero-premium Medicare Advantage plans are possible. But most enrollees do still have to pay the premium for Medicare Part B. (In 2024, the standard premium for Medicare Part B is $174.70/month.) 8
As of 2023, 73% of all Medicare Advantage enrollees only had to pay the Medicare Part B premium, as their plans did not have any additional premiums. 12
Some Medicare Advantage plans pay some or all of the Part B premium on behalf of their enrollees, further reducing the monthly cost of the coverage.
People who are eligible for full Medicaid coverage (in addition to Medicare) do not have to pay Part B premiums. 21 And people who are eligible for a Medicare Savings Program may find that one of the programs covers the cost of Part B for them. 22
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Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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Beyond your initial opportunity to enroll in Medicare plans, the federal government provides other windows for enrollment and plan changes each year.
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