This article was updated on December 1, 2020.
Medicare Advantage, or Medicare Part C, is Medicare coverage offered through private insurance companies that are approved and regulated by Medicare. Under Medicare Advantage, you still have all the coverage you have under Original Medicare (Part A and Part B), and some plans also offer Medicare Part D prescription drug coverage.
Enrollment in Medicare Advantage has grown over three times since 2005, with currently around 20 million beneficiaries. Enrollment is projected to increase to 42 percent of the country by 2028, according to the Congressional Budget Office.
Unlike Original Medicare, Medicare Advantage plans have an out-of-pocket limit, meaning you can only spend a specific amount of dollars on your healthcare each year until your plan covers the rest. This limit will differ from plan to plan and can change each year, but in 2021, no plan’s out-of-pocket limit can exceed $7,550.
Some Medicare Advantage plans include extra coverage such as hearing, vision, dental, wellness benefits, and fitness club memberships.
In addition, some Medicare Advantage plans offer new wellness benefits. Check with your plan to see what it offers. The new Medicare Advantage benefits could include:
- Uber or Lyft rides for non-emergency medical transportation
- Diabetes education & cooking classes
- Appointments with a nutritionist
- Healthy meal & grocery delivery
- Grab bars
- Respite care for caregivers
- Air conditioners & carpet shampoo for asthma sufferers
Otherwise, the coverage you receive should be the same as Original Medicare with the exception of hospice care.
See the chart below for the pros and cons of Medicare Advantage.
What does Part C cost?
With Medicare Advantage, you will pay your regular Part B premium ($148.50 in 2021) plus another premium — the average premium amount is $21 for 2021 — to the private insurer of the plan you choose. Your total costs will vary depending on whether your plan has deductibles, copayments, what types of services you need, and whether you follow rules like using network providers.
Plans vary by state, county, and insurer, so it’s important to do research to find the right plan for you. Some plans have restrictive rules on which doctors and pharmacies you can use, and how to get referrals, so make note of that when doing your research. The rules for your plan can change yearly as well, so double check your Annual Notice of Change each year to make sure your plan’s rules haven’t changed.
Please note that you cannot have these plans at the same time:
- A Medicare Advantage and Medigap plan
- A Medicare Part D plan and Medicare Advantage with Part D benefits
When to enroll
If you are looking to switch from Original Medicare to Medicare Advantage, you can do so during Medicare’s fall open enrollment period from October 15 to December 7. If you are enrolling for the first time, you may enroll in the three months leading up to your 65th birthday, your birthday month, and the following three months.
You can also make changes to your Medicare Advantage plan during the new Medicare Advantage open enrollment period from January 1 to March 31. During this time, you can switch Medicare Advantage plans, or leave Medicare Advantage and return to Original Medicare. If you switch Medicare Advantage plans during this time, your coverage will begin the following month.
How to find a plan
To find a Medicare Advantage plan in your area that’s right for you, use Medicare’s Plan Finder on the official Medicare website. Medicare rates Medicare Advantage plans on a star system, so try to select one with a 4- or 5-star rating. Once you have chosen a plan, you can enroll on the insurance company’s website, call them directly, or call 1-800-MEDICARE. A plan should not call you to get you to join, and should never ask for your credit card or bank information over the phone.
For assistance in understanding your choices and in choosing the right plan, contact your local SHIP office.