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What is Medicare Advantage Part C?

Imagine you could have the financial benefit of government subsidized health insurance, while at the same time enjoy the personalized service of a private insurance company.

With Medicare Advantage, you don’t have to let your imagination run too wild.

Medicare Advantage Plans are health insurance options administered by private companies that are funded and approved by the federal government.

Some of the benefits include:

Low upfront costs
Zero premium plans in some locations
Refunds on the Medicare Part B deductible
Additional perks and benefits that are added to the standard Medicare scheme

If this sounds enticing to you, the next step in your research should be understanding the difference between the Medicare Advantage options and original Medicare.

Remember that there are pros and cons to both options. Your task is to decipher which option is more appropriate to your needs. Of course, if you’d like to talk through your options directly with us at any point, please do not hesitate to give us a call.

Let’s have a closer look.

Medicare Advantage vs Medicare

Both Medicare Advantage (Part C) and Medicare are comprised of the same basic components—Medicare Part A and Medicare Part B:

Medicare Part A is hospital insurance
Medicare Part B is medical insurance that includes services such as inpatient and outpatient doctors’ visits, medical equipment and physiotherapy.

While you receive the benefits of both Part A and Part B on both original Medicare and Medicare Advantage, the way in which you receive them differs. Here’s how.

If you have original Medicare, Parts A and B will be delivered to you directly by the U.S. Center for Medicare and Medicaid Services.

In the case of Medicare Advantage, however, your dealings will be with a private company that is sanctioned to provide Medicare replacement plans to the public. These companies are paid a fixed amount by the government to issue this service to you.

One benefit of choosing Medicare Advantage is that you have the freedom to change plans every year with minimal hassle.

What does Medicare Part C cover?

While Medicare Part C provides the same basic benefits as Original Medicare, the coverage can extend further in various incidences.

Many companies that administer Medicare Advantage also offer additional benefits on top of those included in Medicare Parts A and B. This can be a huge plus for those looking to extend their coverage further afield—but be warned. As we shall see in a moment, there are two very distinct avenues you can choose when it comes to comprehensive coverage, and Part C is only one of them.

Supplementary Benefits

Medicare Advantage supplements may include dental, vision, and hearing, as well as health and wellness benefits such as gym usage, to name but a few. Depending on the plan, these are either included in your premium or are chosen by the patient as an add-on service through their provider.

While this sounds promising, the good news is heralded in with a word of caution. It is important to note that Medigap insurance plans that provide supplemental coverage to original Medicare enrollees are not available to Medicare Advantage beneficiaries.

This means you have to do your research very carefully. When making your coverage decisions, it is vital to scrutinize the benefits of

Original Medicare + Medigap

versus

Medicare Advantage

The other side of the coin is that while upfront costs are difficult to swallow, Medicare Advantage plans will generally have copays and coinsurance when you need to use it. Discussing all benefits with a licensed agent is the best way to make an informed decision on the plan that will fit your needs.”

Drug coverage

In many cases, Medicare Advantage Plans include drug coverage (or what is known as Medicare Part D.) However, not all Advantage plan types offer this as part of their coverage.

If drug coverage is important to you, make sure it is included in the plan type you choose. Alternatively, see to it that you are able to enroll in a separate drug coverage plan that will not put you too out of pocket.

On the topic of your pocket, you might be wondering at this stage what the cost of a Medicare Advantage Plan is.

What does a Medicare Advantage Plan cost?

There is no simple answer to this question, as Advantage health insurance comes in all different shapes and sizes.

What we can tell you about are the types of payments you might be making as a Medicare Advantage Plan holder.

While Medicare is government sponsored, there are certain out of pocket costs that it’s important to be aware of when it comes to Medicare managed care.

Here is a list of key questions to ask before deciding on a plan:

Is there a monthly premium?
What Medicare deductibles does the plan cover?
What sort of copayments are there for doctors’ visits?
Are there charges for going out of a stipulated network of providers?
What is the annual medical spending limit?
Are there additional charges for add-on benefits?

If you would like help answering these, or any other questions, please feel free to contact us. We know what a challenging decision this can be, particularly if you are unfamiliar with the terrain. We are here to help.

And now for your next class at Medicare Advantage University! Let’s have a look at the different plan types.

Types of Medicare Advantage Plans (2022)

There is a range of medicare replacement plans, and it can be difficult to understand which is best for you. We’ll give you a quick rundown of some of the basic options available to bring you a few steps closer to your final decision.

Preferred Provider Organization (PPO)

PPO plans are centered on a chosen network of healthcare providers. This can be a very good option if the network includes doctors and hospitals that you are happy to go to, and that fall within your immediate geographical area. If you go with this option, it would be advisable to stick within the approved network as much as possible, as going outside of it may mean you’ll incur out-of-network costs.

Health Maintenance Organization (HMO)

A HMO plan will generally require you to select a primary care doctor from a specific network of chosen healthcare providers. Again, if you choose this plan, make sure that you use it with caution so you don’t get surprised with unforeseen costs down the line. Another very common element of an HMO plan is that you will be required to get a referral should you want to see a specialist.

Private Fee-For-Service (PFFS)

This is no longer a very common plan type, so it is unlikely that you will come across it too often. It does give you more freedom to choose a doctor or hospital that takes Medicare, provided they also agree to the PFFS terms.

Special Needs Plans (SNPs)

If you have a severe or disabling chronic condition, you might be eligible for a SNP. These plans specifically tailor your benefits to your needs and can be an excellent option if you meet the criteria.

Dual Eligible Special Needs Plans (D-SNPs)

Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility.

Institutional Special Needs Plans (I-SNPs)

Institutional Special Needs Plans (I-SNPs) are SNPs that restrict enrollment to MA eligible individuals who, for 90 days or longer, have had or are expected to need the level of services provided in a long-term care (LTC) skilled nursing facility (SNF), a LTC nursing facility (NF), a SNF/NF, an intermediate care facility for individuals with intellectual disabilities (ICF/IDD), or an inpatient psychiatric facility.

Is Medicare Part C right for me?

Now for the big question—is Medicare Part C the best choice for your needs? We hate to be the bearer of bad news, but there is no simple to answer to this. Different patients have different needs, both in terms of their health and their finances.

Here’s the upside. If you are looking for a supplemental coverage with minimal startup costs and the freedom to change your plan from year to year, Medicare Advantage can be a good option for you.

However, it is vital to bear in mind that Medicare Advantage can be shrouded in unpredictable costs if you are not constantly on top of the limitations of your own coverage. It can also be more difficult to see a specialist than it would be with Medicare Supplemental Insurance, which does not require a doctor’s referral.

We would love to chat through the various options available to you. We also offer free quotes that will help you weigh up the various options on the table.

Why not get in touch? Finding the right health insurance for you is our passion. We don’t simply want to stick you with a plan that will not work for you down the line. We want you to feel confident that you made the right decision from a well-informed basis.

Our Mission is to Become America’s Most Respected Medicare Insurance Brokerage …