What is Part C - Medicare Advantage?
Medicare Advantage Plans, also known as "Medicare Part C or MA Plans," are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits.
There are 2 types of Medicare Advantage Plans:
- Managed Care Organizations (PPO or HMO)
- Private Fee-for-Service (PFFS)
Medicare Advantage Plans receive payments from Medicare to provide you with the benefits covered by Medicare, including Part A and Part B. These companies must follow rules set by Medicare.
Most Medicare Advantage Plans include Part D prescription drug coverage.
Who is Eligible for Part C?
You must have Medicare Part A and Part B, and you must live in the plan's service area to be eligible.
People with end-stage renal disease (ESRD) or permanent kidney failure cannot join a Medicare Advantage Plan.
What do Medicare Advantage Plans Cost?
With a Medicare Advantage Plan, you must still pay your Part B premium.
Your out-of-pocket costs in a Medicare Advantage Plan depend on:
- monthly premium
- yearly deductible
- cost of each visit or service (copays)
- type of services you need and how often you receive them
- whether or not your plan includes Part D - prescription drug coverage
- if you use in-network providers (if your plan is an HMO or PPO)
- extra benefits for which the plan charges
- if you get extra help from your state or Medicaid
Most Medicare Advantage Plans have little to no monthly premiums, but all have copays at the doctor's office and hospital. The total cost of the premiums, copays, and deductibles is often less that the total costs for coinsurance, copays, and deductibles when on Original Medicare only.
Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you'll pay nothing for covered services. This limit is different between Medicare Advantage Plans and can change each year.
Each Medicare Advantage Plan charges different premiums and has different costs for services, so it is important to check these before you sign-up with a plan.
What do Advantage Plans Cover?
Medicare Advantage Plans must cover all of the services that Original Medicare covers, except for hospice care. Original Medicare covers hospice care even if you're in a Medicare Advantage Plan.
In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care, even if you're traveling outside of your network area.
The plan can choose not to cover the costs of services that aren't medically necessary under Medicare. if you're not sure whether a service is covered or not, check with your provider before you get the service.
Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs.
Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D). You will need to check to make sure that all of your prescriptions will be covered on the plan's formulary list before enrolling in the plan.
Important things to remember about Medicare Advantage Plans
- You are still in the Medicare Program
- You still have Medicare rights and protections
- You still get complete Part A and Part B, they are just provided by the Medicare Advantage Plan
- You can only join a plan during certain times of the year; therefore, you are enrolled in the plan for one
- You can join with a pre-existing condition, except end-stage renal disease (ESRD)
- You have to follow the plan rules; if enrolled in an HMO, you must use their network of doctors
- You cannot be charged more than Original Medicare for services like chemotherapy, dialysis, and
skilled nursing care
- You have a yearly limit on your out-of-pocket costs for medical services
- If the plan decides to stop participating in Medicare, you can join another plan, switch to a Medicare
Supplement, or go back to Original Medicare
- You can NOT have both a Medicare Advantage Plan and a Medicare Supplement plan; it is illegal to
If you would like to discuss your existing Medicare Advantage Plan, or if you are newly eligible for Medicare and would like to enroll in a Medicare Advantage Plan, please refer to the “Contact Us” section of our website. We welcome the opportunity to sit down with you to discuss your Medicare insurance needs.