Medicare Part C

Medicare Advantage

What is Medicare Advantage (Part C)?

Doctor showing the benefits of Medicare Part CMedicare Part C is a program which allows you to enroll in private health insurance that offers both Medicare Part A and Part B benefits. Medicare Advantage plans are not supplemental insurance, but rather health insurance plans of their own. Medicare Advantage can also include prescription drug coverage in addition to vision, hearing, and dental. In most cases, you can join even if you have been diagnosed with a pre-existing condition, except for final stage renal disease.  Medicare Advantage plans must follow guidelines established by Medicare but also vary in terms of costs and rules.

Payments and Enrollment?

Most Advantage plans have lower co-payments than the Original Medicare plan, but are also limited to certain service areas and often involve networks. You can only enroll in a plan during certain times of the year, but you will remain enrolled in most plans for a year. The amount that you pay yourself varies from plan to plan, so it is necessary to compare plans in order to find the plan most suitable to your needs. You can enroll in plans in paper, by telephone, or by an online application.

What are my Options?

  1. Health Maintenance Organization (HMO) plans are required to cover both Part A and Part B health care, but can also offer additional benefits. You will only be able to visit physicians and hospitals that are within the HMO network unless there is an emergency. However, HMOs can lower costs, making them (in some cases) less expensive than Original Medicare.
  2. Preferred Provider Organizations (PPOs) allow you to use doctors, hospitals, and specialists within the PPO network. However, you are permitted to use health providers outside of the network at an additional cost to you without a referral.
  3. With a Private Fee for Service (PFFS) you are able to use any doctor or specialist, so long as they accept the terms, fees, and conditions of the PFFS. The plan chooses how much it will pay for the services, and you can spend more or less on PFFS plans than on the Original Medicare plan.
  4. Medicare Special Needs (MSA) plans are limited to people with certain diseases, disabilities, or other health needs and customized to fit the needs of that specific group, including people who have diabetes. They may also be Medicaid/Medicare dual eligible SNPs.
  5. In a Medical Savings Account (MSA) you do not pay a monthly premium because you have a high deductible. You must pay the Medicare Part B premium, and must also pay for Medicare covered services, and after you reach the deductible, the plan will pay for Medicare services. You will also have a savings account in which Medicare will deposit money for your health care costs. MSA plans do not include prescription drugs.

Are there any risks and what if I’m not satisfied?

No matter what plan you choose, you will be protected and covered by Medicare Part A and Part B. If you are not satisfied with your plan, you can enroll in the Original Medicare program. If the plan opts to end its involvement with Medicare, you will need to choose another plan or enroll in Original Medicare.