Managed Medicare plans are health insurance plans that private companies run. They are also known as Medicare Advantage or Part C plans.
Managed Medicare plans are an alternative option to Original Medicare plans, which include parts A and B.
Individuals can enroll in managed Medicare (Medicare Advantage) plans instead. These plans offer the same coverage as Original Medicare plans but typically include benefits they do not cover, such as vision, dental, and hearing.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The term “managed care”
HMOs
HMOs typically require enrollees to receive care and services from in-network providers. Exceptions to this rule include:
- out-of-area urgent care
- emergency care
- temporary out-of-area dialysis
HMOs generally charge a monthly premium in addition to the Part B premium. Enrollees also typically need to choose a primary care physician (PCP).
HMO plans usually include prescription drug (Part D) plans. However, some plans may not offer this. If a person enrolls in an HMO that does not offer prescription drug coverage, they cannot enroll in a separate Part D plan.
PPOs
PPOs also have a network of providers. However, enrollees do not need to use in-network providers for care and services. Since they are preferred, a person will pay less using an in-network provider and pay more for an out-of-network provider.
Individuals with a PPO plan do not need to choose a PCP. These plans also typically charge a monthly premium in addition to the Part B premium.
Most PPO plans include prescription drug coverage. However, if a person enrolls in a plan that does not include this, they cannot enroll in a separate Medicare drug plan.
Other plan types
Other types of managed care (Medicare Advantage) plans include:
- Private Fee-for-Service Plans (PFFS): PFFS plans determine how much they will pay doctors and other providers and how much the enrollee must pay for services. Individuals with these plans can see any provider that accepts Medicare. PFFS plans may offer prescription drug coverage. If they do not, a person can join a separate Medicare drug plan.
- Medicare Medical Savings Account (MSA) Plans: MSA plans allow someone to choose their own provider and do not typically have a network of providers. These plans do not generally charge a monthly premium, though individuals must continue to pay the Part B premium. MSA plans do not offer prescription drug coverage — people need to join a separate Medicare drug plan.
Learn about Original Medicare vs. Medicare Advantage.
The costs of Medicare managed care plans vary according to the insurance company providing them. These may change each year. The company, rather than Medicare, decides how much to charge for premiums, deductibles, and services.
The average monthly premium for Medicare Advantage plans in 2024 is $18.50.
Along with the monthly premium for the Medicare managed plans, a person must continue to pay the Part B premium. In 2024, the standard Part B monthly premium is $174.70.
Individuals can compare the costs of Medicare managed (Medicare Advantage) plans on the Medicare website.
Individuals are eligible for Medicare when they reach 65 years old. They may also be eligible early if they have specific disabilities or conditions, such as end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
People can join a Medicare managed care plan (Medicare Advantage) instead of Original Medicare. They can do this if they meet the following criteria:
- They have Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
- They live within the service area of their chosen plan.
- They are a United States citizen or legal resident of the U.S.
There are also certain times of the year — known as enrollment periods — when a person can sign up for Medicare managed care plans or change their plan. These enrollment periods include:
- Initial Enrollment Period (IEP): This is the period for those new to Medicare. It begins 3 months before their 65th birthday and ends 3 months after their birthday.
- Open Enrollment Period (OEP): This period falls from October 15 to December 7 each year. During this time, people can join a Medicare Advantage plan, switch from Original Medicare to Medicare Advantage, or vice versa, and make changes to their plans.
- Medicare Advantage Open Enrollment: This period falls from January 1 to March 31 each year and is for those who already have a Medicare Advantage plan.
Once a person finds a plan they are happy with, they can enroll online.
They can also contact the insurance company directly by visiting its website or calling to discuss their plan options.
Alternatively, individuals can call Medicare at 1-800-633-4227 to talk about enrollment options.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare managed care plans are also known as Medicare Advantage or Part C plans. They are alternative plans to Original Medicare, which includes parts A and B.
Medicare-approved private insurance companies administer these plans. They offer the same coverage as Original Medicare and may also offer extra benefits, such as dental and vision.
Individuals can compare plans on the Medicare website. They can also enroll in plans online or speak to either Medicare or the insurance company on the phone for enrollment information.