A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, also called “Part C” or “MA Plans” are offered by Medicare-approved private insurance companies that must follow rules set by Medicare. Most Medicare Advantage Plans include presciption drug coverage (Part D).

In most cases, you’ll need to use health care providers who participate in the plan’s network. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services. Some plans offer non-emergency coverage out of network, but typically at a higher cost. In many cases, you may need to get approval from your plan before it covers certain drugs or services.

If you join a Medicare Advantage Plan, you’ll still have Original Medicare but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. You must present the card you received from your Medicare Advantage Plan to get your Medicare-covered services, but keep your red, white, and blue Medicare card in a safe place because you might need it later.

Medicare Advantage Plans provide all of your Part A and Part B benefits, excluding clinical trials (clinical research studies), hospice services, and for a temporary time, some new benefits that come from legislation or national coverage determinations. Be sure to contact your plan if you have questions about covered services.

With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn’t cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine check ups or cleanings). Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs that Part D doesn’t cover, and services that promote your health and wellness. Check with the plan before you join to see what benefits it offers, and if there are any limitations.

Plans can also tailor their benefit packages to offer additional benefits to certain chronically-ill enrollees. These packages will provide benefits customized to treat specific conditions. Although you can check with a Medicare Advantage plan before you join to see if they offer these benefit packages, you’ll need to wait until you join the plan to see if you qualify.

Medicare pays a fixed amount for your coverage each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care). These rules can change each year. The plan must notify you about any changes before the start of the next enrollment year.

Medicare pays a fixed amount for your coverage each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

However, each Medicare Advantage Plan can also have their own set of rules for you to follow. They can charge different out-of-pocket costs, require referrals to see specialists and force you to use doctors, facilities and suppliers that belong to the plan’s network. .

These rules often change each year and it is good to remember that you have the option each year to keep your current plan, choose a different plan, or go back to Original Medicare.

Most Medicare Advantage Plans include Medicare drug coverage (Part D). In certain types of plans that don’t include Medicare drug coverage (like MSA Plans & some PFFS Plans), you can join a separate Medicare drug plan.

However, if you join a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) Plan which doesn’t cover drugs, you can’t join a separate Medicare Part D Plan.

In this case, you’ll either need to use other prescription drug coverage you have (like employer or retiree coverage), or go without drug coverage. If you decide not to enroll in a Medicare prescription drug plan when you’re first eligible and you don't have creditable coverage, you may have to pay a permanent late enrollment penalty if you join a plan later.