Glossary Term

Medicare Advantage

Medicare Advantage are private health insurance plans that deliver the benefits of Medicare Part A and Part B to its enrollees along with supplemental benefits. As a health plan, Medicare Advantage delivers its benefits through a network of health care providers (such as an HMO or PPO). Original Medicare, in contrast, does not restrict enrollees to a network, though a health care provider must accept Medicare’s payment rates as payment in full. Medicare Advantage enrollees must be Medicare-eligible and have applied for coverage during the annual Open Enrollment Period unless there was a qualifying condition for a Special enrollment Period.

Most Medicare Advantage plans include Part D prescription drug coverage. Prescription drug coverage within a Medicare Advantage plan complies with all the rules of Medicare Part D. Medicare Advantage plans often include additional benefits that are not part of Original Medicare. For example, hearing, vision, and dental benefits are commonly found in Medicare Advantage plans but these benefits are absent in Original Medicare.

If a Medicare Advantage plan does not include prescription drug coverage, it is referred to as a MA-only plan. With or without drug coverage, a Medicare Advantage plan is classified as an instance of Medicare Part C.

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