Medicare Part C
A Medicare Advantage plan is an insurance plan offered by private companies that contract and are approved by Medicare. You may opt to get your Medicare Part A, B and D benefits from a Medicare Advantage plan instead of Original Medicare. Medicare Advantage Plans are sometimes called Medicare Part C. Advantage Plans offer you an alternative to Original Medicare. Four common types of Medicare Advantage Plans (Medicare Part C) include:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private-Fee-for Service (PFFS)
- Special Needs Plans (SNPs)
Medicare Advantage plans were developed and created to provide an alternative to Original Medicare and Medicare Supplemental plans. When you join an Advantage Plan, you are directing Medicare to pay the Advantage plan a set amount of money for your medical care. The Advantage plan will then cover you for your Part A and Part B services. Advantage plans often include your prescription drug coverage as well.
Even though you are no longer with Original Medicare, you will still be required to pay your Medicare Part B premiums. When you are enrolled in an Advantage plan you no longer have Medicare as your insurer.
Advantage plans will have networks, premiums, and copays. You may also be required to get a referral to see a specialist.
Medicare Advantage plans are NOT similar to Medicare Supplement (Medigap) plans. These plans were to designed to give Medicare recipients a lower-premium option other than a Medicare Supplement. Members get their benefits from a private insurance company instead of original Medicare.
Medicare Advantage Coverage
Benefits vary with each Advantage Plan. Each plan will have its own summary of benefits. This summary will allow you to know what your copays will be for your healthcare services. Your plan will offer the same services as Original Medicare, such as doctor visits, surgeries, physical therapy, and so forth.
You will likely have a copay each time you visit your primary care doctor. Those copays are usually between $10 and $20 per visit. When you have to see a Specialist, you will often have a larger copay. This amount is usually around $50 per visit. You will also have some type of copay for hospital stays, surgeries and testing. Those copays are typically much higher. Advantage Plan copays are different from state to state.
Some Medicare Advantage plans will offer some additional benefits. Benefits such as routine dental, vision or hearing may be included. When you are deciding on which Medicare Advantage plan is a right for you, we can help you compare the available benefits between plans.
Medicare Plan Networks
Most Medicare Advantage plans will have some type of network through which you will access your medical care. When you are reviewing Advantage Plans you will see terms like HMO or PPO networks.
HMO (Health Maintenance Organization) networks require you to receive your care only with network providers. This doesn’t apply in emergency situations. As part of the network, you will have to select a primary care physician. Your primary care physician will then be responsible for coordinating a referral if you need to see a specialist.
PPO (Preferred Provider Organization) networks will allow you to see a doctor outside the network. You will have to pay a much higher copay and possibly be responsible higher out-of-pockets for other services received.
When enrolling in Medicare Advantage plans, you have to understand there will be rules and restrictions concerning your medical care. The trade-off is that the monthly premium is usually much less.
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