Medicare Part C

Medicare Advantage Plans

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Medicare Part C, also known as Medicare Advantage (MA), is a health plan option provided by private industry.  The Government’s Medicare organization reviewed each of the private company’s plans and approved each one.  Although these plans generally cover the same services as the original Government’s Medicare Plan, most MA plans offer many more benefits and services.

medicare advantage

 To join a Medicare Advantage Plan, an enrollee must first enroll in Medicare Part A and Part B and pay a monthly Part B   premium to Medicare. In addition, enrollees will then need to pay a monthly premium for the MA Plan. If you join a Medicare   Part C Plan, your Medigap policy will not pay any deductibles, co-payments, or other cost-sharing under your Medicare   Health Plan. Therefore, enrollees must cancel their Medigap policy if they join this Plan.

 

There are several types of Medicare Advantage plans that are currently available:

  1.  Medicare Health Maintenance Organization (HMOs) — This insurance will only pay Health Care that exists within the HMO Network.  In most cases, to visit a specialist is requires a referral from the doctor.
  2.  Preferred Provider Organizations (PPO) – You can see any doctor or specialist. Doctors not in your PPO network will increase out of pocket costs. You can see a specialist without a referral.
  3.  Private Fee-for-Service Plans (PFFS) – An enrollee can make an appointment to see any doctor or specialist, but the medical caregiver must accept the PFFS’s fees, terms, and conditions. 
  4.  Medicare Special Needs Plans – These plans provide insurance for people with certain chronic diseases or other special health needs that fall within the guidelines. These MA Plans must include Part A, B, and D coverage.
  5.  Medicare Medical Savings Account (MSA) – This plan consists of two parts.  (1) A high-deductible insurance plan with (2) a medical savings account that is used to pay for the medical care costs.

General ADVANTAGES of Medicare Part C Plans:

Lower Costs  – In some cases, largely dependent on good present and future health, Medicare Advantage overall out-of-pocket costs (premiums, co-pays, deductibles, co-insurance, etc.) can decrease costs as compared to Original Medicare + Medigap + Prescription Drug Plan.

Increased Benefits – Some Medicare Advantage Plans offer benefits not covered by Original Medicare. These added benefits include prescription drug coverage, wellness/preventive care, vision, hearing, and more.

General DRAWBACKS of Medicare Advantage Plans:

The Federal government closely monitors current Medicare Advantage programs, and in some cases has reduced subsidies paid to the private insurance companies. This reduction has generally resulted in the following changes to the plan:

  • Elimination of the Medicare Advantage Insurance Plan.
  • Increased premiums, co-pays, deductibles, co-insurance, etc.).
  • Reduction of Plan benefits 

Increased Premiums – There have been increased costs for Medicare Advantage programs due to declining health.  

Networks – Medicare Advantage plans generally belong to networks of hospitals and doctor groups.  Obtaining medical care outside of the networks can cause the policyholder to incur increased costs as the Medicare Plan will not pay for care outside of the network without certain approvals.

Time Limitations – Medicare Advantage plan policyholders can only make changes to their policy during certain and limited time periods.