When a member enrolls in a Medicare Advantage (MA) plan, where does their coverage come from?

When a member enrolls in a Medicare Advantage (MA) plan, their coverage comes primarily from the Medicare Advantage plan itself. Medicare Advantage plans are designed to provide an alternative to Original Medicare, offering coverage for hospital and medical services that are often packaged with additional benefits, such as vision or dental care, which are not typically included in Original Medicare.

Medicare Advantage plans are essentially private health insurance plans that are approved by Medicare. They provide all the benefits of Original Medicare (Part A and Part B) but through a private provider, meaning the member's claims and coverage are managed by the MA plan. This shifts their coverage away from Original Medicare and combines it under the terms and benefits dictated by the MA plan chosen by the member.

Although it is theoretically possible for some Medicare beneficiaries to remain covered by other plans, such as an employer plan, when a beneficiary enrolls in a Medicare Advantage plan, their benefits and structure change fundamentally. Therefore, the best understanding of where a member's coverage originates when they enroll in an MA plan is that it comes from the plan itself rather than from Original Medicare or other sources.