Medicare Advantage Insurance Plans

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Medicare Advantage or Part C Insurance Plans

An alternative to original Medicare (Part A and Part B), medicare Advantage plans are health insurance plans that are offered by private health insurance companies and are approved by Medicare. Medicare Advantage health plans like HMOs and PPOs are legally enforced to offer the same benefits as Original Medicare but can also include additional coverage like routine vision, dental benefits, health wellness programs or prescription drugs. Medicare Advantage Plan provides all of Part A and Part B coverage along with some extra coverage like vision, hearing, dental, along with health and wellness programs.  

Medicare Advantage plan comes as a package where you have Part A, Part B and usually Part D together in one plan. In this plan you have one ID card that you can use at hospital, doctor’s office as well as pharmacy. Most of the Advantage plans have built-in Part D drug plan, however in some areas you can find them without Part D. This plan resembles with group insurance benefits that you may have had through former employers. There is a local network of health care providers from whom you can avail the health care services. You need to pay copays for many routine services like doctor’s visits, lab work, ambulance, surgeries, hospital stays, urgent care and more.   

Medicare Part C is an alternative to traditional Medicare and is optional so it is not essential for everyone to avail Part C.  

Eligibility for Part C

All Medicare beneficiary regardless of their age can buy Part C, provided they meet the below given criteria:

  • Enrolled in both Medicare Part A and B. Most of the individuals have misconception that they can drop Part B if they enroll in Part C but this is not the case and if one drop Part B then one will be immediately kicked out of Part C plan.
  • Medicare Part C eligibility is based on the address that one’s have on file with Social Security, as one needs to live in the plan’s service area. Some of the Part C plans are specific to only one or two counties while some might span in the entire state, so one needs to choose a plan that operates in that same county.
  • Patients of End-stage Renal Disease is not given Medicare Part C plan.  

Medicare Part C Coverage

Medicare Part C or Advantage Plans cover everything that Original Medicare Part A and Part B cover that basically includes:

  • Lab tests
  • Inpatient hospital care
  • Doctor visits
  • Surgery
  • Skilled nursing facility care
  • Some Home Health care
  • Emergency and Urgent care
  • Durable medical equipment like walkers and wheelchairs
  • Preventive services like certain vaccines

Medicare Part C may also cover some additional services which are usually not covered by Original Medicare. Such additional services include:

  • Prescription drugs
  • Routine dental care
  • Routine vision care including eyeglasses
  • Fitness benefits
  • Routine hearing care including hearing aids

However coverage of supplemental benefits may vary from plan to plan. Some Part C plans may pay $1,000 every three years for hearing aids while some plans may not even cover hearing aids.

Cost of Medicare Part C Plan

The cost varies from plan to plan of Medicare Part C, generally the cost you pay include:

A monthly premium – It is the amount which you need to pay every month irrespective of the fact that whether you use the plan’s services or not. Some of the Medicare Advantage plans have a $0 monthly premium but must continue paying your Part B premium.     

A deductible – It is the amount that you pay before your plan starts reimbursement. Some of the Part C plans have separate deductibles for medical expenses and prescription drugs and plans don’t even have deductibles.

Copayments or coinsurance – It is the amount which you pay every time on receiving the healthcare services. Like you may pay a certain amount to visit your primary care physician and a specific amount to visit a specialist.   

Medicare Part C plans have an annual out-of-pocket maximum, which is a set amount that you pay. After paying this amount all of your covered medical expenses are paid by the plan. Original Medicare has no out of pocket maximum.

Different types of Medicare Advantage Plans

Medicare Part C plans varies and generally depend on the insurance company offering it, so while looking to buy Part C plan it is always a good idea to compare the different plan options available in your specific area. Some of the common Medicare Plan C plans that may be available in your location include:

Health Maintenance Organization (HMO) plans – In this plan you get a network of doctors and hospitals to avail healthcare services. The cost of visit to the doctor and prescription drugs are subject to the plan approval. In case if you avail services from health care providers outside of the plan network, then you may need to pay the entire amount from your pocket. Even if you need to see a specialist, then you need to get a referral from your primary care doctor.  

Preferred Provider Organization (PPO) plans – Medicare Part C PPO plans also provides a network of doctors and hospitals for you to choose a doctor and hospital of your choice. Though you have the option to visit a health care provider outside of the plan’s network but you will need to pay higher out-of-pocket costs. However, in this plan you do not need to have a primary care doctor and you also don’t require referrals from specialist care.

Private Fee-for-Service (PFFS) plans – In this Part C plans you can visit any Medicare approved doctor or hospital, if the plan’s payment terms and conditions are accepted by the provider. While receiving treatment you just need to keep in mind that the doctor and the hospital has contract with the Part C plan.

Special Needs Plans (SNPs) – These plans are designed especially for individuals who have certain chronic conditions or are institutionalized or qualify for both Medicare and state Medicaid. Individuals enrolled in these plans are offered with benefits, provider options as  well as prescription drugs.

Medicare Medical Savings Account (MSA) plans – These are the high deductible Part C plan with a medical savings account. If you are enrolled in this plan then every year your MSA will deposit certain amount of money into your savings account which you can use to pay for your medical expenses before you reach your deductible amount. After reaching the deductible amount your plan will start paying for medicare covered services. These plans do not cover for prescription drugs but if required you can enroll in a stand-alone Medicare prescription drug plan.

Enrollment Period for Medicare Part C

If you are looking to enroll in medicare Part C plan then you can enroll during your initial enrollment period when you get Part B plan. Beside this, every year there is a Fall Open Enrollment Period during which you can sign up for a Medicare Part C plan or you can also switch from one Medicare Advantage Plan to another or you can even drop your plan and return to Original Medicare Plan. This period is known as Annual Election Period and it runs from October 15 to December 7. There is also a Special Enrollment Period for certain cases and if you qualify for this period you will be able to sign up for a Medicare Advantage plan during this period. This period gives opportunity to those individuals who lose coverage due to moving out of the plan’s service area.

Why Sign Up for Medicare Advantage Plans

You need to know few facts about Medicare Advantage plans that will help you decide that whether these plans are best for you or not. Some of the vital facts related to these plans include:

  • Most of the Medicare Advantage plans provides prescription drug coverage
  • These plans also offers extra benefits like fitness programs or gym memberships
  • Some of the Advantage plans also help you save money on your health-care expenses, as some plans have premiums as low as $0 per month.
  • Every Medicare Advantage plan comes with an annual out-of-pocket maximum spending limit. After you spend approved medical costs during one calendar year you don’t need to pay for covered medical services for the rest of that year. The out-of-pocket limit varies with plans and from year to year.

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