Medicare Advantage Plans (MA / MAPD)
Medicare Advantage Plans (also called Medicare Part C plans) are an alternative way to receive your Medicare benefits through a private insurance company approved by the Centers for Medicare & Medicaid Services (CMS).
If you enroll in a Medicare Advantage Plan, CMS pays the insurance carrier a monthly amount called a “capitated payment” to manage your healthcare. The amount paid varies based on factors such as:
- Your county or region
- Health conditions
- Dual eligibility status (Medi-Cal/Medicaid)
- The plan’s CMS star rating
In Southern California counties such as Los Angeles, Riverside, San Bernardino, and Orange County, these payments can range from approximately $900 per month to over $4,000 per month depending on the member’s health profile and eligibility status.
Because CMS pays the Medicare Advantage carrier directly to manage your care, Original Medicare is no longer the primary payer. For this reason, it is generally illegal for anyone to sell you a Medicare Supplement (Medigap) policy while you are actively enrolled in a Medicare Advantage Plan unless you are switching back to Original Medicare.
How Medicare Advantage Plans Work
Most Medicare Advantage Plans are low-cost or even $0 premium plans, although you must remain enrolled in both:
- Medicare Part A
- Medicare Part B
All Medicare Advantage Plans are required to cover all medically necessary services covered by Original Medicare.
Most plans also include prescription drug coverage and are referred to as:
- Medicare Advantage Prescription Drug Plans (MAPD)
Each insurance carrier has its own formulary (list of covered medications), which is why it’s important to review your prescriptions carefully before enrolling in a plan.
HMO Networks & Referrals
Most Medicare Advantage Plans use HMO provider networks. This means:
- You select a Primary Care Physician (PCP)
- Your PCP is part of a contracted medical group
- Specialist referrals are usually required within the same medical group network
Choosing the right Medicare Advantage Plan is important because different plans are designed for different healthcare needs, provider networks, and prescription drug coverage.
Part B Premium Reduction Plans
Unless you qualify for premium-free Medicare Part B through Medi-Cal or another Medicare Savings Program, you are generally responsible for paying your Medicare Part B premium.
Fortunately, some Medicare Advantage Plans offer:
- Part B premium reduction benefits
- “Giveback” benefits that help reduce your monthly Part B cost
Medi-Cal, Dual Eligible & C-SNP Plans
If you are enrolled in Medi-Cal and qualify as a Full Benefit Dual Eligible beneficiary, you may qualify for additional Medicare Advantage benefits.
Additionally, individuals with qualifying chronic health conditions may qualify for a:
- Chronic Condition Special Needs Plan (C-SNP)
These specialized Medicare Advantage plans may offer enhanced benefits such as:
- Grocery allowances
- Utility assistance
- Over-the-counter benefits
- Prepaid debit card allowances
- Additional care coordination services
Finding the Right Doctors & Medical Groups
Provider networks vary significantly between plans.
If you have specific doctors, hospitals, or medical groups you want to keep, we can help you compare plans to determine which options may provide access to:
- UCLA affiliated providers
- Cedars-Sinai affiliated providers
- Local physician groups
- Hospitals and specialists in your area
Some providers participate with certain plans but not others, making plan selection especially important.
Additional Benefits
Medicare Advantage Plans have different:
- Out-of-pocket maximums
- Copays
- Coinsurance amounts
- Provider networks
Many plans also include ancillary benefits such as:
- Dental coverage
- Vision benefits
- Hearing coverage
- Chiropractic services
- Acupuncture
- Gym memberships and fitness programs
Carriers We Represent
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Anthem Blue Cross (Elevance)
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Aetna
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Alignment Health Plan
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Beam
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Blue Shield of CA
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Cigna
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Delta Dental
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Health Net
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HealthSpring
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Humana
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Kaiser
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Imperial Health Plan of California
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LA Care
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Medico/Wellabe
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Molina
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SCAN
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Sutter Health
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UCLA Health Medicare Advantage
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United Concordia
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UnitedHealthcare / AARP
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VSP
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WellCare / Centene
Ready to Compare Medicare Advantage Plans?
Whether you’re new to Medicare, relocating, losing employer coverage, or reviewing your current plan options, we can help you compare Medicare Advantage Plans available in your area.