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Home > SHIC > Medicare Advantage Plans
Medicare Advantage Plans

Medicare Advantage plans are available from private companies that contract with the Centers for Medicare and Medicaid Services to provide Medicare benefits to enrollees. These plans provide your coverage of Part A (hospital) and Part B (outpatient) instead of the federal government providing it. Medicare Advantage Plans are found under Part C of Medicare, when you get Medicare through a private insurance company.

All Part C plans include some amount of cost sharing (copays, coinsurance and deductibles). As a result, these plans are required to have a maximum out-of-pocket amount defined. If during the course of a year the beneficiary reaches that maximum, then teh insurance covers 100 percent of health care costs for the remainder of the year.

Here are some general features of the Medicare Advantage Plans:

  • The plan must provide all benefits that are provided by Medicare; however, they can reimburse each benefit at a different level
  • The plan may provide additional benefits than Medicare
  • Residents must live in the plan's service area
  • Members must have Medicare Part A and B
  • Members must not have end stage renal disease
  • Members may pay the plan a monthly premium
  • Members usually charge a copayment or coinsurance for services rendered
  • Some Medicare Advantage Plans offer prescription drug coverage
  • Claims go directly to the Medicare Advantage company and bypass Medicare
  • Medicare Advantage Plans are NOT supplements; and Medicare Supplements do not work with Medicare Advantage Plans
Is Medicare Advantage right for me?
  • Do my doctors and hospitals accept the plan's terms and conditions?
  • Do I need a referral to see a specialist?
  • What costs are involved in the plan?
  • Can I afford the annual out-of-pocket limit?
  • If I am not satisfied with the Medicare Advantage Plan, will my supplement take me back?

North Dakota Insurance Department
600 E. Boulevard Ave.
Bismarck, ND 58505-0320
Phone 701.328.2440
Toll free 800.247.0560
Fax 701.328.4880

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