What is a Medicare Advantage plan?

A Medicare Advantage (MA) plan is a type of health insurance option that is offered by private insurance companies that comply with Medicare rules. These plans are designed to provide Medicare beneficiaries with an alternative to the traditional Medicare coverage. Medicare Advantage plans are also known as Medicare Part C or MA plans and are available to individuals who are enrolled in both Medicare Part A and Part B.

MA benefits may include prescription drug coverage (Plan D), dental and vision care, and wellness programs. In addition, Medicare Advantage plans may also offer lower out-of-pocket costs than traditional Medicare coverage.

Benefits of Medicare Advantage Plans

One of the key features of Medicare Advantage plans is that they operate as a network of providers. This means that individuals who enroll in a Medicare Advantage plan will typically be required to receive care from providers who are within the plan’s network. This can be a significant advantage for individuals who want to ensure that they receive care from high-quality providers who are knowledgeable about their specific health needs.

Another benefit of Medicare Advantage plans is that they often offer additional services and benefits that are not covered by traditional Medicare. For example, some Medicare Advantage plans may offer transportation services to and from medical appointments, home health care services, and even fitness programs. These additional benefits can be especially important for individuals who have complex medical needs or who require additional support in managing their health.

Who can Enroll in Medicare Advantage Plans?

In order to enroll in a Medicare Advantage plan, individuals must first be enrolled in Medicare Part A and Part B. They must also live within the service area of the Medicare Advantage plan they are considering. It is also important to note that individuals cannot be enrolled in both a Medicare Advantage plan or a Medigap policy at the same time.

Medicare Advantage Plans have different out-of-pocket costs and can implement different rules on the services offered each year. Beneficiaries need to be made aware of such changes before the start of the next year of coverage. It’s important to consider that when an individual joins a Medicare Advantage Plan, the same rights and protections would apply as the Original Medicare.

Drawbacks of Medicare Advantage Plans

One potential drawback of Medicare Advantage plans is that they may limit the choice of providers that individuals can consult with. This means that individuals who have established relationships with specific providers may need to switch to a new provider in order to receive care within the plan’s network. Out-of-pocket costs need to be considered for certain services or procedures before finalizing the MA plan coverage.

Another important consideration when selecting a Medicare Advantage plan is the plan’s star rating. The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage plans on a scale of one to five stars based on a variety of factors, including the plan’s quality of care, member satisfaction, and customer service. Plans with higher star ratings may offer better benefits and a higher level of customer service than plans with lower ratings.

Knowing the Different Medicare Advantage Plans

  • Health Maintenance Organization (HMO) plans
  • Preferred Provider Organization (PPO) plans
  • Private Fee-for-Service (PFFS) plans
  • Special Needs plans (SNPs)
  • Medical Savings Account (MSA) plan


Medicare Advantage plans offer a range of benefits and services that can be a valuable option for individuals who are enrolled in Medicare. These plans can provide additional benefits, lower out-of-pocket costs, and a network of providers who are knowledgeable about an individual’s specific health needs. 

If you’re a healthcare provider and your organization accepts Medicare Advantage plans, you might need to keep track of your documentation for better reimbursement, in those cases, an HCC coding software is always a good idea, feel free to check out Inferscience’s HCC Assistant here.


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