The Ultimate Guide to Medicare Advantage

Medicare Advantage

Medicare Advantage Plan or MA Plan is a compound alternative to the Original Medicare. It is commonly known as MA Part C and has a comprehensive approach to healthcare insurance. It can make your healthcare plans more inclusive by providing coverage for services not covered by Original Medicare.

An enrollment update released by Kaiser Family Foundation reveals that 48% of Medicare plan holders also have Medicare Advantage Part C.

What is Medicare Advantage?

A healthcare plan provided by private insurers approved and guided by Medicare is called Medicare Advantage. It offers coverage for Medicare Part A for hospital insurance, Medicare Part B for medical insurance, and sometimes Medicare Part D for drug coverage.

Additionally, its benefits include certain non-Medicare services like vision care, in-home support, dental care, and caregiver provision.

A MA Plan doesn’t cancel out your Original Medicare Plan. You will have to continue paying your monthly premiums on your existing plans in addition to what you are paying for MA Part C.

Since all Medicare Advantage Plans are bound by Medicare rules and regulations, they cannot charge more than the standard for services like dialysis and chemotherapy. However, they can restrict you to use service providers only in their network, aside from limiting your out-of-pocket choices by charging exuberant amounts for non-Medicare services.

Who Can Use Medicare Advantage?

Any lawful US citizen who is 65 or older, has a disability, or has an existing medical condition can benefit from Medicare Advantage. This includes permanent kidney failure, end-stage renal disease (ESRD), and amyotrophic lateral sclerosis (ALS). Note that no MA Plan covers hospice care.

Further requirements entail living in the same area as your service provider and being an existing Medicare Part A & B member.

How Does MA Work?

Private MA insurers receive a fixed amount—a fee per se, for each individual enrolled in their healthcare plan. Policyholders also pay them for all out-of-pocket charges as they provide many non-Medicare services and benefits. Individuals needing constant vision or dental care and children with hearing disabilities can benefit from MA.


Medicare Advantage doesn’t work with Medicare Supplement Insurance (Medigap); you can’t buy or use it to pay for any of your Medicare Advantage premiums and copayments. Considering how an MA Plan covers drug prescription, outpatient, and hospital services, you don’t need Medicare Supplement Insurance anyways.

Types of Medicare Advantage Plans

You can choose from a variety of MA Plans based on your specific needs, payment restrictions, and obligations.

Here are some types of MA Plans to get you started

Private Fees-For-Service (PFFS)

This MA Plan doesn’t require choosing a primary care doctor or getting a referral to a specialist. Almost all PFFS have an established network of providers, allowing you to pay less than the standard to use their services.

Out-of-service providers and services may cost more, and sometimes, even refuse to treat you even if you have been treated by them before, except for emergencies. Hence, ensure your healthcare providers, hospitals, doctors, and specialists have agreed to your MA Plan payment plan.

In PFFS, your plan provider will decide the amount you need to pay to healthcare providers and services. You can find more information about this in the “Evidence of Coverage” and “Annual Notice of Change” documents they send yearly.

You can’t use your Medicare card for PFFS services and will need a benefits card provided by your plan provider after enrollment.

Health Maintenance Organizations (HMOs)

These MA Plans will require you to pay Medicare Part B premiums along with an additional premium for their benefits. You might have to pay a higher premium if your plan includes drug coverage, but you won’t need Medicare Drug Coverage Part D.

Like most MA Plans, you must use services and providers in your plan provider’s network. You can be exempted from this in case of an emergency, urgent out-of-area care, and dialysis. HMO Point-of-Service is a variant of HMO plans, allowing you to use out-of-network services for additional coinsures and copayments.

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Many HMO plans require you to acquire a referral and choose a primary care doctor, but for out-of-network services, you must ask for prior approval.

Special Needs Plans (SNPs)

These are tailored Medicare Advantage Plans serving groups with specific needs and characteristics. All Medicare SNPs provide drug coverage and have several specialists onboard for the group they serve.

Anyone living in a special care home requiring constant nursing care, people with permanent disabilities, and specific chronic conditions like ASL, ESRD, and dementia can apply for SNPs at any time.

Medicare Advantage Premiums & Cost

The MA premium was almost 19.52 dollars in 2022, though it is expected to decline by a dollar and a half in 2023. MA Plan holders must pay the monthly premium of 164.5 dollars in 2023 for their Medicare Part B along with the MA premiums. As for the out-of-pocket expenses, they can go as high as 7,550 dollars for an HMO.

Learn more about Medicare Advantage Plans from the experts at Medicare Service. They help you review your options based on your specific needs and budget.

You simply need to do is enter your ZIP code on their website, and they’ll connect you with the best Healthcare Insurance Service in your area. They provide quick and efficient solutions to all your healthcare needs and are just what you need to help you out of a healthcare crunch.


Your health should be the single most important thing in your life, as it controls every aspect of your life, from your profession to your personal relationships.

The healthcare system is a tricky path to maneuver, but if you know what you want from your healthcare insurance and do your due diligence with research, you might have a good chance of getting out of a health crisis without any debt.

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About the Author: Nicky Bella

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