Medicare Part C or Medicare Advantage plan is a health insurance plan, which is an alternative to Original Medicare and offered by private health insurance companies. Medicare Advantage plans are required to offer the same benefits as Original Medicare and can also include additional coverage such as routine vision or dental benefits, health wellness programs, and prescription drugs. Costs and coverage of Medicare Advantage plans vary depending upon the insurance company and the county in which the beneficiaries reside.
Benefits of Medicare Advantage Plan
One benefit of the Medicare Advantage plan is that beneficiaries can even get prescription drug benefits or Medicare Part D benefits included in the same plan rather than having to enroll in a separate stand-alone Medicare Prescription Drug Plan. Medicare Advantage Plan that comes with prescription drug coverage is known as Medicare Advantage Prescription Drug Plan that offers combine benefits of Medicare Part A, Part B, and Part d through a single plan.
How to Save Money while Purchasing Medicare Advantage Plan?
Beneficiaries should understand that there are different kinds of Medicare Advantage plans, and costs may vary even among plans of the same type depending upon their area. Beneficiaries may save money while buying an Advantage plan by finding a plan in their area that comes with the extra benefits that are required by them. For example, if a beneficiary wears glasses then he/she should look for an Advantage plan that includes routine vision care. This will prevent them from buying a separate vision plan. Similarly, beneficiaries having dental issues should consider buying an Advantage plan that covers routine dental care. Beneficiaries who gym regularly to stay active can purchase a Medicare Part C plan that includes gym memberships.
Vital Facts related to Medicare Advantage Plans
- Medicare Advantage plan may come with cost-sharing amounts like coinsurance, co-payments, and annual deductibles. In 2019, the average monthly premium of a Medicare Advantage plan was $8 as per eHealth research.
- To be eligible for a Medicare Advantage Plan beneficiaries should be enrolled in Medicare Part A and Part B plan.
- Beneficiaries should live within the plan’s service area.
- Every Medicare Advantage plan comes with a maximum out-of-pocket spending limit for a year and if the beneficiary spends up to that limit on their covered health-care services, then the plan covers their approved medical costs for the remaining year. The average out-of-pocket maximum in 2019 was $5,164, which was down from $5,815 in 2018.
Different Types of Medicare Advantage Plans
Different types of Medicare Advantage plans may be available in a county and beneficiaries are advised to compare the Advantage plans available in their area to find the best plan at highly affordable price. Different types of Advantage plans include:
Health Maintenance Organization plans
HMO plans come with a network of doctors and hospitals that members of the plan are required to use. Members visiting doctor or hospital outside the plan network may need to pay the full cost out of pocket with the only exception of emergency care. Members are required to obtain a referral from their primary care provider to visit a specialist.
Preferred Provider Organization
Medicare Advantage PPO plans also come with a doctors and hospitals network and members are free to choose a doctor and hospital of their choice within the network. Unlike the HMO plans, beneficiaries have the opportunity to receive medical care outside of the plan’s network but will require to pay higher out-of-pocket costs. Besides, members don’t need to have a primary care doctor and they also don’t need referrals for specialist care.
Private Fee-for-Service Plans
This Medicare Advantage plan allows its members to visit any Medicare approved doctor or hospitals as long as plan’s payment terms and conditions are accepted by the provider. Members of this plan should make sure that every time they should receive treatment from a healthcare provider having contract with the plan.
Special Needs Plans
These plans are designed only for people having certain chronic conditions, or who are institutionalized, or who qualify for both Medicare and state Medicaid. All the plan’s benefits including provider options and prescription drugs are designed to cater the needs of the enrollees.
Medicare Medical Savings Account Plans
These plans are a combination of a high deductible Medicare Advantage plan with a medical savings account, which the enrollees can use to pay for their medical expenses before reaching the deductible. After this, their plan will pay for Medicare-covered services. However, prescription drug coverage is not included with this plan.