Alternatives to Original Medicare

Medicare Advantage Plans include the standard benefits available through Medicare Part A and Part B, along with additional benefits. Most Medicare Advantage Plans cover Medicare Part D prescription drug coverage. You can enroll in a Medicare Advantage Plan as an alternative to Original Medicare.

Medicare Advantage Plans are similar to HMOs and PPOs. These plans are offered by private companies that contract with Medicare to provide you with Medicare Part A and Part B coverage, except hospice care. Hospice care is covered under Original Medicare, even if you’re enrolled in a Medicare Advantage Plan.

All Medicare Advantage Plans cover emergency and urgently needed care, but each plan can choose whether or not to cover the costs of services that aren’t medically necessary. These plans may also include additional coverage like dental, vision, and hearing, as well as health and wellness programs.

Types of Plans

There are two versions of Medicare Advantage Plans — those that include prescription drug coverage (known as “MAPD plans”) and plans that don’t (known as “MA plans”). Each type of Medicare Advantage Plan will offer a specific type of doctor network, including HMO, PPO, and private Fee-for-service (FFS) plans.

Medicare pays a fixed amount for your care every month to companies that offer Medicare Advantage Plans. While these companies must follow rules set by Medicare, they are free to charge different out-of-pocket fees, and they can set rules for how you access health care.

IMPORTANT: If you purchase a Medicare Advantage Plan, you don’t need – and cannot be sold – a Medigap policy.

Helpful Tips

  • Not all Medicare Advantage Plans work the same way, so it’s important to take the time to carefully compare plans before choosing one. Learn more on our Choosing a Medicare Plan page.
  • If you enroll in a Medicare Advantage Plan, you have the right to appeal a decision if the plan says a service or item isn’t medically necessary.
  • You can also ask the plan for a written advance coverage decision. That way you can make sure a service is medically necessary and will be covered.

Want to know more about Medicare Advantage Plans? Call us at 1-877-470-3108, TTY 711, or visit our Find Coverage page to get started.

 

Medicare has neither reviewed nor endorsed this information.