A Medicare Advantage plan, sometimes called a Part C plan, is a health plan offered by a private insurer like CDPHP® to provide Medicare Part A coverage (inpatient hospital visits, skilled nursing facility stays, home health care visits, hospice care) and Part B coverage (doctor visits, outpatient services, preventive care, some home health visits). It replaces Original Medicare (the federal government program that administers Parts A and B) and usually includes Part D prescription drug coverage, as well as other benefits. Medicare Advantage plan options include HMO and PPO plans. Individuals must have both Part A and Part B to enroll in a Medicare Advantage plan.
Medicare Advantage Plan FAQs
What do Medicare Advantage plans cover? Medicare Advantage plans cover all services required by Original Medicare, plus any additional services offered by the private insurer.
What are my out-of-pocket costs for a Medicare Advantage plan? That depends on the plan you choose. For an idea of what your costs may be, get a free Medicare plan quote.
How is a Medicare Advantage plan different from traditional Medicare coverage? Medicare pays a fixed amount each month to CDPHP for the coverage CDPHP offers under its Medicare Advantage plans, and CDPHP follows Medicare’s rules with respect to services that must be provided. However, CDPHP also offers additional benefits not covered under Original Medicare, like dental, vision, and prescription drug coverage, support programs, and wellness programs.
CDPHP Medicare Advantage HMO plan options include medical-only or medical plus Part D prescription drug coverage. HMO plans require you to use network providers for all your health care, except in emergency or urgent care situations. If you do go to an out-of-network provider, neither Medicare nor CDPHP will be responsible for the costs, and the provider may seek payment from you.
With Original Medicare, you have a deductible and 20 percent coinsurance for medical services like primary care physician visits, specialist visits, urgent care copays, emergency room copays, outpatient surgery, and various diagnostic tests like lab and radiology services. If you select a Medicare HMO plan through CDPHP, you would simply pay a copay for these same services.
CDPHP also offers Medicare Advantage PPO plan options that include medical-only and medical plus Part D prescription drug coverage. These plans provide more flexibility when choosing doctors and other providers, and restrictions for seeing out-of-network providers are fewer. If you use an out-of-network provider, your plan may cover a portion of the fee (though it could be at a lower rate than for an in-network provider). As with HMO plans, you’ll pay a set copayment for services and office visits.
For more information on whether a Medicare Advantage plan is the right choice for you, give us a call at (518) 641-3400 or toll free 1-888-519-3364 (TTY/TDD: 1-877-261-1164) Monday through Sunday, 8 a.m. to 8 p.m. October 1 through February 14 and from 8 a.m. to 8 p.m., Monday through Friday the rest of the year.
The benefit information provided here is a brief summary, not a complete description of benefits.