Innovation & Insights

Understanding Medicare Advantage Plans: What You Need to Know

11 November 2024

Medicare Advantage Plans, also known as Part C or MA Plans, are an alternative way to receive your Medicare Part A (hospital insurance) and Part B (medical insurance) coverage. These plans are offered by Medicare-approved private companies and must adhere to rules set by Medicare. Many Medicare Advantage plans also include prescription drug coverage, referred to as Part D, making them a comprehensive option for those seeking all-in-one health care coverage.

So how do they work?

When you join Medicare Advantage, Medicare pays a fixed amount each month to the private company offering your plan. This payment covers the cost of your Medicare services under Part A and Part B. However, these plans often have their own rules about how you receive care, which can vary based on the plan. For example, some plans may require you to get a referral to see a specialist, while others may limit your choice of doctors, facilities, or suppliers to those within the plan's network for non-emergency or non-urgent care.

Each year, the rules and costs associated with Medicare Advantage may change. You will receive an Annual Notice of Change (ANOC) before the start of the new enrollment year, usually by September 30, outlining any updates to your plan.

What do they cover?

Medicare Advantage plans provide all the benefits of Original Medicare, with a few exceptions. They cover most Part A and Part B services, but not certain costs related to clinical trials, hospice care, or kidney transplants. Additionally, some new benefits introduced by legislation or national coverage determinations may be temporarily excluded.

One of the biggest advantages of Medicare Advantage is the potential to cover services that Original Medicare does not. These may include fitness programs, vision, hearing, and dental care (such as routine exams or cleanings), offering more comprehensive healthcare options. Additionally, Medicare Advantage typically has a yearly out-of-pocket maximum, meaning once you hit this limit, you won’t have to pay any further out-of-pocket costs for Medicare-covered services. Most Medicare Advantage plans also include prescription drug coverage (Part D).

Providence Medicare Advantage plan

With a Providence Medicare Advantage plan, you get all the benefits of Original Medicare and more. While benefits and availability vary by plan and county, all Providence Medicare Advantage plans include coverage for preventive visits and hospital stays.

Providence Medicare Advantage also often covers access to a nurse advice line and a personal emergency response system.

Additionally, most plans include prescription drug coverage, $0 preventive dental, hearing and vision coverage, telehealth and fitness center membership with access to health and wellness classes.

Medicare Advantage plans offer flexibility, but it’s essential to understand how they work, what they cover, and how they fit into your healthcare needs. Always review your options carefully to ensure you are getting the coverage that’s right for you.

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Providence Health Assurance is an HMO, HMO‐POS and HMO SNP with Medicare and Oregon Health Plan contracts. Enrollment in Providence Health Assurance depends on contract renewal.