Medicare Advantage/PDP

Medicare Advantage/PDP Plans

They cover all Medicare services and may also offer extra coverage.

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There are a few things your clients should know

  • Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If your clients join a Medicare Advantage Plan, they’ll still have Medicare. They’ll get their Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.
  • Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if they’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, they’re always covered for emergency and urgently needed care.
  • The plan can choose not to cover the costs of services that aren’t medically necessary under Medicare. If they’re not sure whether a service is covered, they should check with their provider before they get the service.
  • Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to their Part B premium, they usually pay a monthly premium for the Medicare Advantage Plan.
  • If they need a service that the plan says isn’t medically necessary, they may have to pay all the costs of the service, but they have the right to appeal the decision.