Medicare Advantage (Part C)

Medicare Part C or Best Known as Medicare Advantage

A type of Medicare health plan offered by private companies that contract with Medicare to provide you with all your Part A and Part B benefits. If you’re enrolled in a Medicare Advantage plan, Medicare services are solely covered through the private company and aren’t paid for under Original Medicare.

Medicare Advantage comprises a variety of private health plans, most often HMO’s (Health Maintenance Organization) and PPO’s (Preferred Provider Organization). Every plan must cover all the same benefits that traditional Medicare covers. With Medicare Advantage plans, they can charge different co-payments, co-insurance, deductibles and max out of pockets depending on the plan and carrier and or plan. Since these type of plans work has HMO’s & PPO’s there are networks of hospitals and doctors. Many of the insurance companies that offer these plans charge a monthly premium in addition to the Part B premium, in most cases the Medicare Advantage plan premiums are much more affordable then Medicare Supplement (Medigap) plans.

If you are not wanting to go through the trouble of  dealing with networks or referrals, you may want to consider a Medicare Supplement or a Medigap policy. With these types of plans you can choose any doctor or hospital that works with Medicare and there are no referrals needed to see specialists. These plans are typically more expensive in price but the benefits are normally better.

Medicare Advantage Plans Cover More Than Just Part A & B

With choosing a Medicare Advantage plan you no longer are actually using the benefits of Original Medicare Parts A or B. Most of the Medicare Advantage plans already include prescription drug coverage at no additional cost. As we have seen over the years with these plans though, the prescriptions drug coverage that is included within it, typically has higher co-payments on many of the drugs compared to a traditional standalone Medicare Prescription Drug (Part D) plans. In most all cases, you cannot be on a Medicare Advantage plan and a stand alone Part D plan at the same time. Typically the only way to get a traditional Part D plan is to have Original Medicare with a Medicare Supplement (Medigap). If you wanted to go this route, then most individuals would have 3 types of plans; Original Medicare, Medicare Supplement (Medigap) and Prescription Drugs (Part D). These would take place of a Medicare Advantage plan. With Medicare Supplements, the premiums are typically higher, but almost all the time the benefits and the networks are much better.

Some Medicare Advantage plans do cover routine hearing and vision services, usually as a separate package for an additional premium though. All plans, by law, have annual limits on out-of-pocket costs. Another difference from the traditional program is that most plans require you to go to doctors and other providers within their service network or pay higher copay’s for going out of network.

There are pro’s and con’s to Medicare Advantage Plans:

Some pros:

  • They are typically cheaper in price then Medicare Supplement plans.
  • They normally include prescription drug coverage.
  • You can switch them once a year during the annual enrollment period with guaranteed acceptance.
  • And SOME plans include dental & vision coverage.

Some cons:

  • Since they are cheaper in price, normally the benefits aren’t as good as Medigap plans.
  • There are networks of hospitals and doctors you have to go to, whereas with Medicare Supplements or Medigap, you can go to any doctor or hospital that accepts Medicare.
  • The plan benefits & premiums typically change once a year (January 1st), this isn’t always a bad thing but over the years we have seen the cost rise and the benefits lower.

There is much more that goes into these plans other than whats listed above and on our site. If you want to ensure that you are making the correct decision please feel free to call our highly trained Medicare agents at the number on the screen.

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