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What is a Medicare Replacement Plan

If you’ve heard of a Medicare replacement plan, it’s the same as an Advantage plan. Advantage plans are also known as replacement plans because, in a way, they replace Original Medicare. If you’re thinking about signing up for an Advantage plan, we’re here to tell you everything you need to know.

How Does a Medicare Replacement Plan Work?

Replacement plans, Advantage, or Part C, plans stand-in for your Medicare for each year you’ve enrolled. They don’t act as a permanent replacement, and you can always return to Medicare during the Medicare Advantage Open Enrollment Period or Annual Enrollment Period. The way these plans work is by providing benefits through a private insurance company rather than through Medicare.

When enrolled in an Advantage plan, you must use the plan’s network of providers to be covered. When signing up for an Advantage plan, you must have enrolled in both Parts A and B.

Does a Medicare Advantage Plan Replace Medicare?

Again, an Advantage plan doesn’t permanently replace Medicare. However, it acts as your primary coverage. Medicare pays private insurance companies offering Advantage plans to handle beneficiary claims and benefits.

The Advantage plan must offer the same benefits as Parts A and B. They often also provide additional services and perks, such as prescription drug, dental, vision, and hearing plans, or free gym memberships.

If you enroll in an Advantage plan, check your Summary of Benefits. This document will let you know what’s not covered, as well as list copay amounts for which you’ll be responsible.

Additionally, your benefits are subject to change each year. As an Advantage enrollee, you’ll want to keep your eyes out for your Annual Notice of Change letter to make sure you’re still happy with your plan. You should expect to get this letter in September, right before the Annual Enrollment Period.

What is the Best Medicare Replacement Plan?

The best Advantage plan for you depends on your needs. Indeed, it also depends on if you would benefit from enrolling in an Advantage plan at all. When making a decision, consider how much the downsides to Medicare Advantage plans would affect you.

Some people find the networks restrictive, and they pay more than they save in copays outside their network. On the other hand, others who don’t need to visit many doctors enjoy having one plan for all their needs and spending less than they would for a Medigap plan.

If you’re considering enrolling in an Advantage plan, be sure to go with a top-rated carrier. Also, ensure that you’re familiar with how the plan you’ve chosen works.


Is a Medicare Advantage plan the same as a Medicare replacement plan?
Yes – it’s just another way of saying Advantage plan.
Can I switch from a Medicare Advantage plan back to Original Medicare?
Yes – each year, you have two opportunities to switch from an Advantage plan. The Medicare Advantage Open Enrollment Period (January 1 through March 31) and the Annual Enrollment Period (October 15 through December 7).
Which is better, Medicare Supplement or Advantage plan?
Whether you should choose a Supplement or Advantage plan depends on your needs. If you see many specialists, a Medigap plan would be better due to Advantage plans’ network restrictions. Otherwise, if you can’t easily afford a Medigap plan, an Advantage plan could work.
Can a Medicare Advantage plan drop you?
If you don’t pay your premium for your plan or Part B, your Advantage plan can drop you. Likewise, if you move outside the service area, they can drop you. Otherwise, your plan will typically auto-renew.

Get Help Understanding Medicare Replacement Plans

If you need more information or help to choose the right plan for you, give us a call today. We offer plans from top-rated carriers.

You can also complete our online rate form to see rate quotes for your area.

Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

16 thoughts on “What is a Medicare Replacement Plan

  1. My mother has a Medicare Advantage PPO plan. She is paying UHC and Medicare. Why would she be paying for both?

    1. Hi Celine! In order to enroll in either a Medicare Advantage plan or Medigap plan, you must be enrolled in Part B.

  2. I am writing for my Uncle, He has a platinum blue plan in MN (medicare replacement) He had gotten a shot that was experimental for CA and medicare denied, he was not sure he signed an ABN. If that goes to his medicare replacement plan and he has an ABN signed, is he responsible for that cost or does the other insurance have to write it off since it is a replacement plan. His medicare EOB says he is not responsible, so it should be written off. But my understanding is that if a replacement plan is billed that they follow medicare guidelines and pt is not responsible for that.

  3. How can we know if a patient actually has Medicare & not a replacement plan? Many patients call our office claiming they have Medicare when in fact they have a replacement plan which ends up not covering them fully.

    1. Hi Melissa! This is a great question, the issue is very common. Since a lot of beneficiaries don’t really understand what coverage they have, unfortunately, it’s up to the staff to ask the right leading questions. A great leading question is if their plan includes extra services like dental, vision, & hearing. If they say yes, then that’s a red flag that the plan is a replacement plan. Another good leading question is if they have a network. If the answer is yes, that’s another red flag. The staff needs to be educated on the differences between Medicare and Medicare Advantage so they can better vet patients before coming in. The only way around that is to call Medicare directly when the patient is checking in at the front desk. Medicare will only speak to you if the patient is there.

  4. If a patient has a Medicare Advantage plan and is in a Swingbed for 10 days. we have to file a shadow claim to Medicare to let them know. Do those days count against the Medicare days if the patient switches back to traditional Medicare

    1. Hi Christie. I believe so if it’s within the same benefit period or calendar year. However, this is tricky. I would contact Medicare directly to confirm.

  5. My brother-in-law is on a Medicare advantage plan and he now needs to go into short term skilled nursing them transition him to long term care through Medicaid I am having trouble getting him into a facility because they are using his secondary insurance first is that correct. Should he sign up for straight Medicare?

  6. With a Medicare replacement plan will it pay for a women’s yearly exam, every year or every other year? Do you have to use preventive cpt codes per age group or only use the G and Q codes accordingly. Thank you, Beth

    1. Hi Beth! Medicare Replacement plans must provide coverage for the same services as Original Medicare. An annual pap smear is covered every 24 months or every 12 months for women at high risk. Unfortunately, I’m not familiar with cpt codes since we do not bill Medicare. You may be able to find the correct cpt codes here.

  7. I am 66yrs old woman and have a pacemaker and I also have diabetes. I take Eliquis 5mg, Synthroid 75mcg, Mirapex 4.5mg, Glimepiride 1mg mg, glyxamb25mg-5mg, Potassium 10mg 3 daily ,Pantoprazole Sodium DR 40mg, , Gabapentin 300mg, Lantus insulin, I take 40units , Repatha Sureclick, 140units, Sotalol 80mg. I have been trying to find an insurance that will cover my medicine and health care needs so my husband can retire but so far I haven’t found one that will work . Most want more out of pocket prices than my $890.00 I get from Social Security. My husband of 48 years has good insurance that has only a 20% co-pay. Do you know of any way to get me insurance that will let me get the medicines that I need without taking every penny I get and let my husband retire.

    1. Without speaking to you over the phone to go over the specifics, it’s hard to determine what plan would work for you. When looking at GoodRx, all the medications you listed are covered. Only two of them say 50% of plans will cover the medication. I would recommend using the Medicare plan finder tool. It will let you input all your medications and then see what plans cover them and how much your out of pocket costs will be. You will want to look at both Medicare Advantage plans and Part D.

  8. My 42 y/o so is a Type I diabetic. He is in desperate need of a continuous glucose monitor due to critically sporadic low blood sugars. He is covered on his wife’s health plan at work. His secondary is Medicare. His wife’s Cigna’s said they will cover only 20% of the cgm cost, and that’s only after he reaches his yearly $7500 deductible. Medicare wont cover it because he has a primary insurance. Would an Advantage plan cover the costs associated wit this monitor and monthly sensors? Thank you, Lynne

    1. Hi Lynne! Thank you for your question! Medicare Advantage plan benefits are decided by the carrier, so what you pay out of pocket for each service will be different for each carrier. For example, you could pay $100 out of pocket with Cigna for a CGM, but you may only pay $20 out of pocket with another carrier for the same CGM. The only way around this is if you make Medicare his primary coverage, assuming his employer has more than 20 employees. If you make his Medicare coverage primary, you shouldn’t have that deductible to meet. I would suggest speaking to his benefits administrator to see what all his options are and to make sure his employer coverage is considered creditable under Medicare. I hope this helps!


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