Medicare Part C

Medicare Part C – Medicare Advantage Plans

One of the options a Medicare beneficiary has as a resource to tackle Original Medicare’s Coinsurance, Copays, and Annual Deductibles is through the use of a Medicare Advantage plan, also known as Medicare Part C.

Medicare Advantage Plans are CMS approved insurance plans offered through private health insurance companies. They combine original Medicare Part A, Part B, and generally Part D into one plan. Enrolling in a Medicare Advantage plan requires a person to enroll in Medicare Part A & B and reside in the plan’s service area. Medicare Advantage plans, at a minimum, include all benefits, services, and coverages outlined in original Medicare.

(CMS = Centers for Medicare & Medicaid Services)

They generally have additional benefits and services Medicare does not cover, such as:

Preventative Care & Wellness Programs.
Comprehensive Dental Coverage.
Vision Exams & Corrective Lenses.
Hearing Exams & Hearing Aids.
Worldwide Emergency Assistance Outside The U.S.

Medicare Advantage plans provide an affordable option to reduce the exposure to Medicare’s copays, annual deductibles, and 20% coinsurance. By selecting a Medicare Advantage plan, the insurance company becomes your primary insurance, and by doing so, it has very distinct advantages and disadvantages, such as:

Advantages:

They Have A Low or No Monthly Plan Premium.
Part D Is Generally Included In The Plan.
They Provide Predictable Out-of-Pocket Costs.
They Usually Include Extra Benefits Not Provided By Original Medicare.

Disadvantages:

As A Rule, Working Within A Network Is Mandatory.
Typically, Working With A Primary Care Physician Is Mandatory.
In General, They Require A Referral To See A Specialist.

Medicare Advantage Plans Are Available As An HMO or PPO.

HMO – Health Maintenance Organization:

They Cover Eligible Services For Providers And Facilities Inside The Network Only, Except In An Emergency.
As A Rule, They Have Narrow Networks Confined To A Specified Geographical Area.
They Limit In-Network Out-of-Pocket Expenses.
Out-of-Network Expenses Are Unlimited And Mostly Out-of-Pocket.
Generally, They Require Pre-Authorization For Procedures.

PPO – Preferred Provider Organization:

They Cover Eligible Services For Providers And Facilities Inside & Outside The Network.
As A Rule, They Have Broad Networks With Nation Wide Coverage.
They Limit Both In-Network & Out-of-Network, Out-of-Pocket Expenses.
Generally, They Do Not Require Pre-Authorization For Procedures.

Choosing a Medicare Advantage plan does not mean a person is bound to the Medicare Advantage plan selected indefinitely during their Initial Enrollment Period. There are enrollment timelines when a person can change their coverage if needed or wanted.

Medicare Advantage Plan Enrollment Timelines.

Annual Election Period Oct 15th – Dec 7th: Compare And Find The Best Plan For The Next Calendar Year.

Coverage Changes One Can Make: