Under Medicare Part C, private companies contract with the federal government to offer Medicare medical benefits to beneficiaries. The plans, called Medicare Advantage (MA), offer beneficiaries another health plan choice for Medicare coverage.
MA includes 3 different kinds of plans: coordinated care plans such as HMOs, PPOs, and plans for patients with special needs; private fee-for-service (PFFS) plans; and Medicare medical savings account (MSA) plans.
Nearly 20 million Medicare beneficiaries—approximately 1 in 3—is enrolled in a Medicare Advantage plan as opposed to having traditional coverage under Original Medicare.
While MA plans are required to offer the services of Original Medicare—comprising Part A benefits (primarily inpatient care) and Part B benefits (outpatient services)—they also can offer additional services such as preventive, vision, and dental. Many MA plans include prescription drug coverage. Because MA plans can vary in the insurance products they offer and in their pricing, it can be confusing for both the patient and provider to determine different MA plans' coverage and cost-sharing arrangements.
CMS requirements for MA plans can be found within the Medicare Managed Care Manual. In addition, the statute that governs Medicare Advantage is the Social Security Act, and the regulations are at 42 CFR Parts 422 and 423.
Below are some resources that help explain the MA program.