Medicare Part C - Medicare Advantage
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.
If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.
Medicare offers different types of health insurance plans. The three types of Medicare health plans are:
– Original Medicare (Parts A and B)
– Medicare Advantage Plans (Part C)
– Medicare Prescription Drug Plans (Part D)
Original Medicare is the traditional government-provided health insurance. It’s a fee-for-service plan, which means you can go to any doctor, hospital, or other provider that accept Medicare patients. However, Original Medicare doesn’t cover everything. You may have to pay some costs out of your own pockets, such as for prescription drugs and routine dental care.
A Medicare Advantage Plan is a private health plan that replaces Original Medicare. These plans must offer all the same benefits as Original Medicare, but they may also offer extra benefits, such as vision, hearing, dental, and health, and wellness programs. Most include Medicare prescription drug coverage (Part D).
Types of Medicare Advantage Plans
Medicare Advantage, also known as Medicare Part C, is another way of getting your Medicare Part A and Part B coverage but with a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn’t cover. Some of these benefits are fitness programs (gym memberships or discounts) and some vision, hearing, and dental services such as routine checkups or cleanings.
Part C Plans are offered by private companies that are obliged to follow the rules set by Medicare. In case you join a Medicare Advantage (MA) Plan, you’ll still have Medicare but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. Part C plans usually include Medicare drug coverage (Part D).
Not all Medicare Advantage plans work the same way. If you have chosen to enroll in a Part C plan, you will need to understand how the different types work so that you can decide which one will suit your needs. There are five kinds of Medicare Advantage plans to consider.
The Five Types Part C Plans
Medicare Advantage plans are categorized into five types of plans.
HMO
Health Maintenance Organizations
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PPO
Preferred Provider Organizations
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SNP
Special Needs Plans
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PFFS
Private Fee-for-Service Plans
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MSA
Medical Savings Account Plans
All of these plans are designed to fill in the gaps in coverage from Original Medicare. Although their goal is the same as that of Medicare supplement plans, the two are vastly different.
Medicare Advantage Enrollment and Eligibility
To be eligible for a Part C plan, you must already be enrolled in Medicare Parts A and B. As long as that requirement has been met, the only individuals ineligible for a Part C plan are those with End-Stage Renal Disease (ESRD).
These need to apply if you are to be considered eligible for a Medicare Advantage plan:
- You live in the service area of the plan you want to join. The plan you wish to enroll in can give you more information about its service area. If you live in another state for part of the year, ask if the plan will cover you there.
- You have Medicare Part A and Part B.
- You’re a U.S. citizen or lawfully present in the U.S.
There are certain times each year when you can enroll in a Medicare Advantage Plan. It is usually best to enroll in a plan by calling 1-800-MEDICARE, rather than by calling the new plan.
Medicare Advantage Costs
Currently, about 30% of Medicare beneficiaries choose to enroll in a Medicare Advantage plan rather than a Medicare supplement. The driving factor is usually the cost. Medicare Advantage plans typically have much lower premiums. However, it is important to understand that no matter which one you enroll in, you will still be responsible for the Medicare Part B premium.
If you are enrolled in a Medicare Advantage plan, your insurance carrier is responsible for your medical bills. You will still pay for expenses and services you receive from providers and be expected to pay for the copays associated with the plan.
Medicare Advantage and Drug Coverage
Many Medicare Advantage plans include prescription drug coverage, so it is uncommon for Part C members to also enroll in a Part D plan. That being said, it is important that you look at the plan’s drug formulary to make sure your medications are covered under the policy.
Let’s briefly discuss each type of Medicare Advantage plan.
