Medicare Advantage
Medicare Advantage (Medicare Part C) is a privately administered alternative to Original Medicare that bundles Part A and Part B and usually Part D, with plan-specific rules a claim must follow.
Updated
Medicare Advantage (Medicare Part C) is a program in which Medicare pays private insurers to provide Part A and Part B coverage — and in most cases Part D prescription drug coverage — to enrolled beneficiaries. A beneficiary in a Medicare Advantage plan receives their Medicare benefits through that plan rather than through Original Medicare and its fee-for-service contractors.
Billing follows the plan, not Original Medicare. A Medicare Advantage claim is submitted to the plan identified on the member's card, may require plan-specific authorization or network participation, and is adjudicated under the plan's rules and contract — not under the Medicare Administrative Contractor that handles Original Medicare in that region.
In practice
Because a Part C plan's rules can differ from Original Medicare's, the identifiers, authorization, and submission destination on a claim all come from the member's plan, not from Medicare defaults. Submitting a Part C member's claim to the MAC as if it were Original Medicare is a common avoidable error.
Commonly confused with
- Original Medicare: Original Medicare is fee-for-service, paid by CMS through a MAC; Medicare Advantage is a privately administered plan that delivers the same benefits under its own rules.
- Medicare Part D: Part D is prescription drug coverage; a Medicare Advantage plan that includes Part D (an MA-PD) bundles it with medical coverage, but standalone Part D plans also exist separately.