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MEDICARE PART C: ADVANTAGE PLAN

If you have Part A and Part B, you can join a Medicare Advantage Plan, sometimes called “Part C” or an “MA plan.” This type of Medicare health plan is offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).

What should I know about Medicare Advantage Plans?

  • You can only be in one Medicare Advantage Plan at a time.
  • You can join a plan even if you have a pre-existing condition.

  • In many cases, you’ll need to use health care providers in the plan’s network. Providers can join or leave a plan’s network anytime during the year. Your plan can also change the providers in the network anytime during the year. If this happens, you may need to choose a new provider. 

    Your plan will notify you that your provider is leaving your plan so you have time to choose a new one. You’ll get this notice if it’s a primary care or behavioral health provider and you have gone to that provider in the past three years. If any of your other providers leave your plan, you’ll get this notice in certain situations. Your plan will also: 

    • Help you choose a new provider to continue managing your health care needs. 
    • Help you continue needed care that’s already in progress. 
    • Notify you about the different enrollment periods available to you and options you may have for changing plans.
  • When an in-network provider or benefit isn’t available or can’t meet your medical needs, most plans will help you get any medically necessary care outside the provider network (at the in-network cost sharing).
  • Some plans offer non-emergency coverage out of network, but it usually costs more. 
  • Plans set a limit on what you’ll have to pay out of pocket each year for covered services.

​​​​​​​Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you may need it for some services, or if you ever switch back to Original Medicare.

Before joining a Medicare Advantage plan
Talk to your employer, union, or other benefits administrator about their rules before you join a Medicare Advantage Plan. In some cases, joining a Medicare Advantage Plan might cause you to lose your employer or union coverage. If you drop or lose employer or union coverage for yourself, you may also lose coverage for your spouse and dependents. You may not be able to get this coverage back.