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Medicare Advantage

How Medicare Advantage (Part C) works

An insurance professional helps an older woman with gray hair understand her Medicare insurance options.

How Medicare Advantage (Part C) works

Scripps can help you learn about Medicare Advantage (MA) insurance plans. Often referred to as Medicare Part C, Medicare Advantage plans are bundled plans that include Original Medicare Care Part A and Part B and usually Part D. 

While Original Medicare (A and B) coverage is offered through the federal government, MA plans are offered by private insurance companies that contract with Medicare to provide both Original Medicare Part A and Part B benefits, plus other benefits and coverage.

You are still in the Medicare program and have Medicare rights and protection if you choose an MA plan. Medicare Advantage plans can be HMOs or PPOs in which you choose from a network of doctors and hospitals for your health care. 

What to know about Medicare Advantage insurance plans

There are important considerations when deciding if an MA plan is better for you or a loved one than Original Medicare. 

  • Medicare Advantage plans may offer additional benefits that Original Medicare (A and B) does not cover, including: 
  • Prescription drugs
  • Hearing aids
  • Dental care
  • Vision care
  • Gym memberships
  • Transportation for medical visits
  • Wellness services
  • You don’t need, and aren’t eligible to buy, Medicare supplemental insurance (Medi-Gap) if you are enrolled in an MA plan. There are limits on your ability to switch back to Original Medicare with a Medi-Gap policy as well.
  • Your out-of-pocket costs may be lower with an MA plan.
  • Medicare Advantage plans have a yearly limit on out-of-pocket costs for medical services. Once this limit is reached, you pay nothing for covered services. Each plan can have a different limit, and the limit can change each year.
  • You are required to reside and receive non-emergency medical care within a geographical area.
  • You must choose providers who participate in the plan’s network. Some plans will not cover providers outside of the network. (Scripps providers participate in several Medicare Advantage plans.)
  • You can join an MA plan if you have a pre-existing condition.

What is the Medicare Star Rating System?

Medicare uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Medicare scores how well plans perform in several categories, including quality of care and customer service. Ratings range from one to five stars, with five being the highest and one being the lowest. 

You can use the overall star rating to compare performance among several different plans. 

How to choose a Medicare Advantage plan

There are many factors to think about when you are selecting a Medicare Advantage plan. Consider your priorities, health care needs, budget, star ratings and what type of insurance you currently have. 

Free options are available to help you find the best MA plan for you, whether you are switching from Original Medicare or enrolling in Medicare for the first time.

When can you sign up?

You can enroll in a Medicare Advantage plan (or switch from one to another) during the following windows:

Medicare Advantage Plans that include Scripps

Scripps is offered through these Medicare Advantage Plans:*

*Scripps is not a health insurance company, but rather a health care provider. Always check with your health insurance carrier to confirm that your preferred physician and facility are in network.