Medicare Advantage Plans
Medicare Part C, also known as Medicare Advantage plans, are Medicare-approved private health insurance plans for individuals enrolled in Original Medicare (Part A and Part B).
What does Medicare Part C (Medicare Advantage) cover?
Medicare Advantage covers all benefits under Medicare Part A and Medicare Part B, plus other options that can include:
How can I get Part C (Medicare Advantage)?
In most cases, you can join a Part C (Medicare Advantage) plan if you meet all these requirements:
- You're enrolled in Part A and Part B.
- You live in the plan's service area.
- You don't have end-stage renal disease (ESRD). Some exceptions may apply.
- You're applying when the plan is accepting new members, or you meet special circumstances.
Types of Medicare Part C plans
There are many options for Part C (Medicare Advantage) plans. We'll highlight the 3 main types that Kaiser Permanente offers. To find out which plans Kaiser Permanente offers in your area, see Medicare health plan descriptions. Or speak with a Kaiser Permanente Medicare specialist by calling toll free 1-855-223-3679 (TTY 711), 8 a.m. to 8 p.m., 7 days a week.
Medicare Advantage HMO plans
Medicare Advantage HMO plans use network providers for your care. By getting care in a coordinated network, you're more likely to have predictable copays and out-of-pocket expenses. If you go to a non-network provider, you may have to cover the costs, unless you're referred by a network provider, or if emergency or urgent care is needed.
Medicare Cost plans
In some areas of the country, you may be able to buy a Medicare Cost plan. With a Cost plan, if you go to a non-network provider, the services are covered under Original Medicare. You'd pay the Part B premium, a monthly health plan premium (if applicable), and any Part A and Part B coinsurance and deductibles.
Medicare Special Needs Plan (SNP)
If you have additional health care needs or a limited income, the Special Needs Plan is a Medicare Advantage plan that might be right for you. You may qualify for a Special Needs Plan if you:
- Live with a chronic or disabling condition
- Live in a nursing home or other institution
- Require an institutional level of care
- Qualify for both Medicare and state Medicaid (Medi-Cal in California).