Medicare Learning Center

Programs

Medicare Advantage (MA) is also known as Medicare Part C, and is an alternative for beneficiaries to Original fee-for-service Medicare. These MA beneficiaries must be enrolled in both Medicare Part A and Part B, and continue to pay Part B premium. Under the MA program, Medicare contracts with and pays private plans to provide benefits and cover services for applicable beneficiaries during annual open enrollments or upon becoming eligible. Open enrollment period currently runs from November 15 – December 31st. Medicare contracts with private plans under this MA or other prepaid categories:

• Local HMOs
• Local  PPOs
• Private Fee-for-Service plans (PFFS)
• Special Needs Plans (SNPs), restricted to beneficiaries who are dually eligible for Medicare and Medicaid; live in long-term care institutions (or would otherwise require an institutional level of care); or (3) have certain chronic conditions.
• Regional PPOs, established to provide rural beneficiaries greater access to MA, and cover entire statewide or multi-state regions.
• Other types of private plans outside the regular MA program (e.g., cost plans, HCPP, PACE, medical savings accounts, demonstrations and pilots)

The Medicare Prescription Drug Program, also known as Medicare Part D, is available to beneficiaries enrolled in Medicare Part A or Part B, who choose to enroll in a Medicare prescription drug plan, either a stand-alone Part D plan or a Medicare Advantage plan with prescription drug coverage.

Medicare Beneficiary Cost Sharing

SOURCE: CMS/Office of the Actuary; Published in CMS Fast Facts July 2021

Medicare Part A/B Persons Served and Payments Made

SOURCE:  CMS/Office of Enterprise Data and Analytics; Published in CMS Fast Facts July 2021

Snapshot Compiled by MCOL, July 2021