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Medicare 101

CommuniCare Advantage provides Medicare Advantage plans

CommuniCare Advantage provides Medicare Advantage plans, which offer benefits in addition to traditional Medicare coverage.

Here’s how it works:

Traditional Medicare coverage is called “fee-for-service” because healthcare providers bill Medicare for each service they provide to a patient. This coverage has three parts:

  • Part A covers inpatient care in hospitals and skilled nursing facilities, plus home health and hospice services
  • Part B covers outpatient and primary care services, including physician and clinical lab services, preventive care, some health screenings, surgical fees and supplies, physical and occupational therapy, radiology
  • Part D, which was added in 2003, covers prescription drugs

Medicare Advantage Plans Offer Additional Benefits

Congress created Medicare+Choice plans, or Part C plans, in 1997. In 2003, they became known as Medicare Advantage Plans. Medicare Advantage Plans offer a more coordinated process to healthcare for older Americans than traditional, fee-for-service Medicare. These plans typically provide extra benefits that may include wellness services, dental care, and vision care. Learn more about benefits

Medicare Advantage plans cover the services offered in Parts A and B. Many Advantage Plans also cover Part D (prescription) services plus additional services. (CommuniCare Advantage does.) About a third of Americans who receive Medicare participate in a Medicare Advantage plan.

Medicare Advantage Plans are offered by private companies such as CommuniCare Advantage that contract with Medicare to provide Part A and Part B benefits. Medicare Advantage plans have certain rules that determine who is eligible and that mandate members to use participating providers.

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Special Needs Plans for Specific Populations

Different Medicare Advantage programs are available for various populations. In 2003, Congress created Special Needs Plans to improve care for the most vulnerable Medicare recipients. Special needs plans may address the unique needs of those living in a nursing facility (the Institutional Special Needs Plan, or ISNP) or the needs of people with chronic conditions such as diabetes, heart failure, or cardiovascular disease (the Chronic Condition Special Needs Plan, or CSNP).

Last modified: 01/04/2022

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