Medicare Advantage (Part C)
What is Medicare Advantage?
Medicare Advantage plans (also called Medicare Part C) are private insurance plans that bundle the same services as Original Medicare Part A (Hospital) and Part B (Medical) and often Part D (Prescription Drug) while generally including some additional benefits, such as dental, vision, and hearing.
Part A (Hospital)
Part B (Medical)
Part C (Medicare Advantage)
Part D (Prescription Drug)
Part A (Hospital)
Part B (Medical)
Part C (Medicare Advantage)
Part D (Prescription Drug)
What are the advantages of Medicare Advantage?
These plans are popular because many offer medical, hospital, prescription drug (Part D), dental, vision, and hearing benefits in one plan. Plus, these plans may offer other benefits, including allowances for utilities, gym memberships, and over-the-counter health items. In addition, 66% of Medicare Advantage Prescription Drug (MAPD) plans offer $0 monthly premiums.
Because private insurers like Clear Spring Health offer Medicare Advantage Prescription Drug plans, you have more flexibility with your plan selection. You can tailor your coverage to fit your healthcare needs, with the average Medicare beneficiary having 43 plans1 from which to choose.
Part C Medicare Advantage
All Medicare Advantage (Part C) plans cover the following:

Hospital

Doctor
Most Medicare Advantage plans cover the following:

Part D
(Make your plan an MAPD plan)
Other benefits you may find in a Medicare Advantage plan include:

Transportation

Vision

Hearing

Gym

Dental

OTC Drug

Utility

Grocery
*Even if you have a Medicare Advantage plan, hospice care will still be paid by your Original Medicare Part A.
What are the disadvantages of Medicare Advantage?
Some Medicare Advantage plans may offer fewer options for doctors and hospitals, as they may have smaller plan networks than Original Medicare. You may need to get a referral to use a specialist. Additionally, providers can leave and join your network at any time.
In many cases, you may need to get approval from your plan before it covers certain drugs or services.
Will Medicare Advantage save me money?
Many Medicare Advantage plans feature low premiums (66% have $0 monthly premiums1) and use a combination of deductibles, co-insurance, and co-pays to share the cost of your services. Cost-sharing usually applies to all the services the plan covers.
Medicare Advantage plans cap your maximum out-of-pocket expenses for Part C covered services. Once you reach the cap, you pay nothing for the rest of the year. Be sure to compare your Medicare Advantage plans’ costs and coverage.
Each Medicare Advantage plan sets its specific costs, but the types of expenses they include are similar. The table below shows the types of costs that plans may apply. For actual costs, read the details of your Medicare Advantage plan.
Premium
Deductible
Co-Pay
Co-Insurance
Frequency
Per Month
Per Year
Per Service
Per Service
Details
You still pay your Part B premium. You may also have a monthly plan premium.
Some plans charge an annual deductible. Original Medicare deductibles don’t apply.
Many plans charge copays for services like doctor visits.
May charge a co-insurance for such things as durable equipment.
Frequency
Details
Premium
Per month
You still pay your Part B premium. You may also have a monthly plan premium.
Deductible
Per year
Some plans charge an annual deductible. Original Medicare deductibles don’t apply.
Co-Pay
Per Service
Many plans charge copays for the services like doctor visits.
Insurance
Per Service
May charge a co-insurance for such things as durable equipment.
What types of Medicare Advantage Plans are there?
- Health Maintenance Organization (HMO) – In most HMOs, you must see in-network providers to receive coverage (except in an emergency). If care is not received from an in-network provider, Medicare will not cover it. Before you see a specialist in your
HMO network, you must generally get a referral from your primary care doctor (except for an OBGYN). - Preferred Provider Organization (PPO) – You can receive care from an out-of-network Medicare provider, but the costs are
higher. In a PPO, you generally do not need a referral to see a specialist or an out-of-network provider. - Private Fee-for-Service (PFFS) – There is no network of providers. Any Medicare provider who agrees to the plan’s terms and
payments can be seen. Providers can decide on a case-by-case and visit-by-visit basis whether to see a Medicare beneficiary. - Medical Savings Account (MSA) –A high deductible must be paid before the plan covers any benefits. A health savings
account is linked to the plan and Medicare deposits money in the bank account each year. However, the amount is less than the
annual deductible. In an MSA, you can see any provider you choose. - Special Need Plan (SNP) – These are PPOs or HMOs that only admit people who meet certain eligibility requirements.
a. Dual Special Need Plan (DSNP) – This is a combined plan for Medicare and Medicaid beneficiaries.
b. Chronic Special Need Plan (CSNP) – This is a plan for people with certain underlying medical conditions.
Not all plan types are available in all areas.
Does Medicare Advantage cover pre-existing conditions?
You can join a Medicare Advantage Plan even if you have a pre-existing condition. Pre-existing conditions do not affect Medicare Advantage enrollment. Some conditions may be better serviced with a Chronic Special Need Plan, which are special plans for these conditions.
Can I add a Medicare Supplement (Medigap) plan to a Medicare Advantage Plan?
No. You can’t be enrolled in a Medicare Advantage Plan and Medicare Supplement Insurance Plan (Medigap) at the same time. If you wish to have a Medigap plan and are enrolled in a Medicare Advantage Plan, you will need to disenroll in your Medicare Advantage Plan and then enroll in Original Medicare and add a Medigap Plan.
To disenroll or enroll in a Medicare Advantage plan, you must be in an enrollment period.
What are the Medicare Advantage enrollment periods?
There are certain times each year when you can enroll in a Medicare Advantage Plan.
Talk to An Agent to Learn More About Plan Benefits

Initial Enrollment
A seven-month period, including the three months before, the month of, and the three months after the month you first become eligible for Medicare (either your 65th birth month or the 25th month you have collected disability benefits).

Annual Enrollment
If you have Original Medicare and want to enroll in Medicare Advantage for the first time, you can choose a Medicare Advantage plan during Medicare’s Annual Enrollment Period (AEP). Medicare’s AEP runs from Oct. 15 to Dec. 7.

Open Enrollment
If you are already enrolled in Medicare Advantage, you can switch to our plan once during the Medicare Advantage Open Enrollment Period (OEP). The Medicare Advantage OEP runs from Jan. 1 to March 31.

Special Enrollment
You can make changes to your Medicare Advantage drug coverage when certain events happen in your life, like if you move or lose other coverage. You may also qualify for a Special Enrollment Period if you miss an enrollment period because of certain exceptional circumstances, like if you are impacted by a natural disaster or an emergency.
Who can join a Medicare Advantage Plan?
To join a Medicare Advantage Plan, you must:
- Be enrolled in both Medicare Part A and Part B
- Live in the plan’s service area
- Be a U.S. citizen or lawfully present in the U.S.
How do I enroll?
You must enroll in Medicare Part A and Part B before joining Medicare Advantage.
Before choosing a Medicare Advantage plan, research if the plan provides coverage for your doctors and specialists, the hospital where you want to receive care, and any special care for your condition.
Contact Clear Spring Health for help choosing a plan and enrolling in a Medicare Advantage Prescription Drug Plan.
Medicare Advantage (Part C)
What is Medicare Advantage?
Medicare Advantage plans (also called Medicare Part C) are private insurance plans that bundle the same services as Original Medicare Part A (Hospital) and Part B (Medical) and, often, Part D Prescription Drug) while generally including some additional benefits, such as dental, vision, and hearing.
Part A Hospital
Part B Medical
Part C Medicare Advantage
Part D Prescription Drug
Part A Hospital
Part B Medical
Part C Medicare Advantage
Part D Prescription Drug
What are the advantages of Medicare Advantage?
These plans are popular because many offer medical, hospital, prescription drug (Part D), dental, vision, and hearing benefits in one plan. Plus, these plans may offer other benefits, including allowances for utilities, gym memberships, and over-the-counter health items. In addition, 66% of Medicare Advantage Prescription Drug (MAPD) plans offer $0 monthly premiums.
Because private insurers like Clear Spring Health offer Medicare Advantage Prescription Drug plans, you have more flexibility with your plan selection. You can tailor your coverage to fit your healthcare needs, with the average Medicare beneficiary having 43 plans1 from which to choose.
Part C Medicare Advantage
All Medicare Advantage (Part C) plans cover the following:

Hospital

Doctor
Most Medicare Advantage plans cover the following:

Part D
(Make your MA plan an MAPD plan)
Other benefits you may find in a Medicare Advantage plane include:

Transportation

Vision

Hearing

Gym

Dental

OTC Drug

Utility

Grocery
*Even if you have a Medicare Advantage plan, hospice care will still be paid by your Original Medicare Part A.
What are the disadvantages of Medicare Advantage?
Some Medicare Advantage plans may offer fewer options for doctors and hospitals, as they may have smaller plan networks than Original Medicare. You may need to get a referral to use a specialist. Additionally, providers can leave and join your network at any time.
In many cases, you may need to get approval from your plan before it covers certain drugs or services.
Will Medicare Advantage save me money?
Many Medicare Advantage plans feature low premiums (66% have $0 monthly premiums1) and use a combination of deductibles, co-insurance, and co-pays to share the cost of the services you use. Cost-sharing usually applies to all the services the plan covers.
Medicare Advantage plans cap your maximum out-of-pocket expenses for Part C covered services. Once you reach the cap, you pay nothing for the rest of the year. Be sure to compare your Medicare Advantage plans’ costs along with coverage.
Each Medicare Advantage plan sets its specific costs, but the types of costs they include are similar. The table below shows the types of costs that plans may apply. For actual costs, read the details of each individual Medicare Advantage plan.
Premium
Deductible
Co-Pay
Co-Insurance
Frequency
Per month
Per year
Per Service
Per Service
Details
You still pay your Part B premium. You may also have a monthly plan premium.
Some plans charge an annual deductible. Original Medicare deductibles don’t apply.
Many plans charge copays for the services like doctor visits.
May charge a co-insurance for such things as durable equipmen.
Frequency
Details
Premium
Per month
You still pay your Part B premium. You may also have a monthly plan premium.
Deductible
Per year
Some plans charge an annual deductible. Original Medicare deductibles don’t apply.
Co-Pay
Per Service
Many plans charge copays for the services like doctor visits.
Insurance
Per Service
May charge a co-insurance for such things as durable equipment.
What types of Medicare Advantage Plans are there?
- Health Maintenance Organization (HMO) – In most HMOs, you must see in-network providers to receive coverage (except in an emergency). If care is not received from an in-network provider, Medicare will not cover it. Before you see a specialist in your
HMO network, you must generally get a referral from your primary care doctor(except for an OBGYN). - Preferred Provider Organization (PPO) – You can receive care from an out-of-network Medicare provider, but the costs are
higher. In a PPO, you generally do not need a referral to see a specialist or an out-of-network provider. - Private Fee-for-Service (PFFS) – There is no network of providers. Any Medicare provider who agrees to the plan’s terms and
payments can be seen. Providers can decide on a case-by-case and visit-by-visit basis whether to see a Medicare beneficiary. - Medical Savings Account(MSA) –Ahigh deductible must be paid before the plan covers any benefits. A health savings
account is linked to the plan and Medicare deposits money in the bank account each year. However, the amount is less than the
annual deductible. In an MSA, you can see any provider you choose. - Special Need Plan (SNP) – These are PPOs or HMOs that only admit people who meet certain eligibility requirements.
a. Dual Special Need Plan (DSNP) – This is a combined plan for Medicare and Medicaid beneficiaries.
b. Chronic Special Need Plan (CSNP) – This is a plan for people with certain underlying medical conditions
Not all plan types are available in all areas.
Does Medicare Advantage cover pre-existing conditions?
You can join a Medicare Advantage Plan even if you have a pre-existing condition. Pre-existing conditions do not affect Medicare Advantage enrollment. Some conditions may be better serviced with a Chronic Special Need Plan, which are special plans for these conditions.
Can I add a Medicare Supplement (Medigap) plan to a Medicare Advantage Plan?
No. You can’t be enrolled in a Medicare Advantage Plan and Medicare Supplement Insurance Plan (Medigap) at the same time. If you wish to have a Medigap plan and are enrolled in a Medicare Advantage Plan, you will need to disenroll in your Medicare Advantage Plan and then enroll in Original Medicare and add a Medigap Plan.
To disenroll or enroll in a Medicare Advantage plan, you must be in an enrollment period.
What are the Medicare Advantage enrollment periods?
There are certain times each year when you can enroll in a Medicare Advantage Plan.
Talk to An Agent to Learn More About Plan Benefits

Initial Enrollment
A seven-month period, including the three months before, the month of, and the three months after the month you first become eligible for Medicare (either your 65th birth month or the 25th month you have collected disability benefits).

Annual Enrollment
If you have Original Medicare and want to enroll in Medicare Advantage for the first time, you can choose a Medicare Advantage plan during Medicare’s Annual Enrollment Period (AEP). Medicare’s AEP runs from Oct. 15 to Dec. 7.

Open Enrollment
If you are already enrolled in Medicare Advantage, you can switch to our plan once during the Medicare Advantage Open Enrollment Period (OEP). The Medicare Advantage OEP runs from Jan. 1 to March 31, or the annual enrollment period for Medicare.

Special Enrollment
You can make changes to your Medicare Advantage drug coverage when certain events happen in your life, like if you move or lose other coverage. You may also qualify for a Special Enrollment Period if you miss an enrollment period because of certain exceptional circumstances, like if you are impacted by a natural disaster or an emergency.
Who can join a Medicare Advantage Plan?
To join a Medicare Advantage Plan, you must:
- Be enrolled in both Medicare Part A and Part B
- Live in the plan’s service area
- Be a U.S. citizen or lawfully present in the U.S.
How do I enroll?
You must enroll in Medicare Part A and Part B before joining Medicare Advantage.
Before choosing a Medicare Advantage plan, research if the plan provides coverage for your doctors and specialists, the hospital where you want to receive care, and any special care for your condition.
Contact Clear Spring Health for help choosing a plan and enrolling in a Medicare Advantage Prescription Drug Plan.
Clear Spring Health agents can help you find a plan.
Shop and compare plans with an agent

Clear Spring Health agents can help you find a plan.
Shop and compare plans with an agent
