Medicare Advantage Plans rules and qualifying plans

Medicare Advantage plans are referred to as MA Plans or Part C. They are given by Medicare approved private companies. If you enrol for Medicare Advantage plans, you have Medicare and will receive Part A and B Medicare covering hospital and medical insurance relating to the Medicare Advantage plans and not from the Traditional Medicare.


Medicare Advantage Plans Covered services

Medicare Advantage Plans cover complete Medicare services. In fact, majority of the Medicare Advantage Plans provide extra coverage such as hearing, vision and dental coverage.


Medicare Advantage Plans Rules

Medicare pays for the care a fixed amount to the companies providing Medicare Advantage Plans. Thus it is expected of such companies to adhere to Medicare set rules.

Each plan of Medicare Advantage can charge as out of pocket costs and this can include different rules for the services, such as:


  • Whether you require to see some specialist only with a referral
  • If you visit facilities, doctors or suppliers for non-urgent or non-emergency urgent care

Keep checking the rules as they change each year.


Medicare Advantage Plans cost

The amount you pay in a Medicare Advantage Plan is based on several factors.


Drug coverage

Majority Medicare Advantage Plans fortunately include Part D Prescription drug coverage.  However, if required you may take a separate plan type that:

  • Does not offer coverage for drug such as MSA plans
  • They chooses not offering coverage for drugs such as PFFS plans


In case you are in HMO or PPO of the Medicare Advantage plans and enrol for a separate Prescription Medicare drug plan, you will be returning to Traditional Medicare by getting disenrolled from Medicare Advantage Plans.

Find the best Medigap plans here

Tips to qualify for Medicare Advantage plans

Generally, being eligible for Medicare Advantage plans is effective on meeting certain conditions:

  • You have coverage for Parts A and B Medicare.
  • You live and enroll in the types of Medicare Advantage plans that is available as service in your area.
  • You do not have crucial diseases namely, the renal disease of the end-stage or dialysis of kidney failure permanently or transplantation of kidney. Of course there are exceptions and availing Medicare advantage plans with ESRD means clarify the plan you wish to buy so that it supports with coverage.


The Medicare Advantage plans costs are not fixed and it may vary with each plan and also is location based. So check if the plan is deductible annually, do they charge monthly premium apart from Part B Medicare premium, are there network restrictions, etc.