Medicare Part C
Medicare Advantage Plans – Part C: A General Overview and How They Differ from Original Medicare (Parts A and B)
A Medicare Advantage plan is another health plan choice you have as a Medicare beneficiary. Also referred to as “Part C” or “MA Plans,” they are offered by private insurance companies who have been approved by Medicare to administer the plan benefits.
Medicare Advantage plans effectively “combine” Medicare Part A and Part B, enhances the benefits somewhat, and offers you a “brand new” Part C plan. Due to the additional coverage, Medigap (or Medicare Supplement) policies are not allowed. Basically, you end up saving on premium dollars but potentially spending more on healthcare due to the various cost-sharing provisions, such as copayments for the various services.
Medicare Advantage (MA) plans provide all of Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. MA plans may also offer extra coverage benefits such as vision, hearing, dental, or health and wellness programs. Many also include Medicare
(Part D) Prescription Drug coverage.Medicare compensates the insurance companies that administer MA plans by paying them a fixed fee for your care every month. These companies must follow strict Medicare guidelines however, each plan can charge different out-of-pocket costs and have different rules for how you receive services. These rules and benefits are also subject to review by Medicare and can change annually. As such, members receive a new Outline of Coverage booklet every year so it’s a good idea to review it in order to keep up with any modifications and changes.
Your Plan Choices
There are several MA plans, but availability and provisions can differ from region to region. The main plans include:
Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Special Needs Plans (SNP)
HMO Point of Service (HMOPOS) Plans
Medical Savings Account (MSA) Plans
For more information on the various options read the article titled, “The Medicare Advantage (Part C) Selection: "Which Plan is Right for You?”
The Cost of Medicare Advantage Plans
Monthly premiums are typically charged in addition to your ongoing Medicare Part B premium. Each MA Plan can charge different premium amounts along with different out of-pocket costs (co-insurance) for the various covered services and benefits, so it’s wise
to carefully compare apples to apples.
Your out-of-pocket costs will depend on:
How much (if any) monthly premium is charged.
Whether the plan pays any portion of your monthly Part B premium.
Whether the plan has yearly or any additional deductibles.
How much you pay for each visit or service in the form of copayments or coinsurance.
The type and frequency of health care services you may require.
How well you adhere to the plan’s rules, such as using network providers and facilities.
Whether you need extra benefits and if the plan covers them.
The plan’s yearly limit on your out-of-pocket costs for all medical services.
Joining a MA Plan
Since MA Plans can vary, you should take the necessary time to compare the available plans in your area. Senior Benefits Network is here to help you select the plan that meets YOUR specific needs and budget.
A Few More Items to Keep in Mind
You can only join (or leave) a plan during certain times/periods of the year.
You still maintain all of Medicare’s protections and rights.
Become familiar with the plan rules, like getting a referral to see a specialist, prior approval for certain procedures, going to certain facilities and so on. Breaking the rules can lead to higher out-of-pocket costs and penalties, depending on the chosen plan.
You can join a MA Plan even if with a pre-existing condition, except for ESRD.
If the plan decides to stop participating in Medicare, you‘ll have to join another Medicare health plan or return to Original Medicare (Part A and Part B).
In regards to the last point, insurance companies can end their annual contract with Medicare and pull out of an area or region. For example, if claims become too high or payments from Medicare too low for a particular region, they have a business decision to make. Should they decide to leave, they are required to give their policy-holders ample notice so they have plenty of time to consider other plans and options.
Additionally, contracts can be modified annually. MA Plan members could see coverage and benefit changes, cost-sharing modifications and premium adjustments.
If you do not care for potential changes and restrictions, you may wish to consider Original Medicare along with a good Medigap (Medicare Supplement) Policy. This would allow you to always know just what your premiums and out-of-pocket expenses (if
any) would be. Plus a Supplement policy cannot be cancelled as long as premiums are paid.
Another consideration is the health condition of the Medicare Beneficiary. Similar to a car, we typically need more “maintenance” as we age. Subsequently, a healthy individual could save money with a MA Plan due to lower premiums and fewer claims and cost-sharing. But what about later on in life (or if currently in poor health)? Although we cannot predict the future, Original Medicare along with a good supplement may be the way to go. The concern is that once you enroll in certain MA Plans, you can only
switch plans under certain conditions. So think hard and plan ahead if at all possible – it could save you or your loved one a lot of expense and headache in the long run.
To help you find plans in your area, Contact Us.