Part C

Medicare Advantage

What is Part C - Medicare Advantage Plan?

 

Medicare Advantage Plans, sometimes called "Part C" or MA Plans," are offered by private companies approved by Medicare, and Medicare pays these companies to cover your Medicare benefits. 

 

There are 2 types of Medicare Advantage Plans:

  • Managed Care Organizations (PPO or HMO)

  • Private Fee-for Service (PFFS)

 

Medicare Advantage Plans receive payments from Medicare to provide you with the benefits covered by Medicare, including Part A and Part B.  These companies must follow rules set by Medicare.

 

Most Medicare Advantage Plans offer plans that included Part D coverage. 

Who is Eligible for Part C?

 

You must have Medicare Part A and Part B, and you must live in the plan's service area to be eligible. 

People with End-Stage Renal Disease (ESRD), permanent kidney failure, cannot join a Medicare Advantage Plan.

What Do Medicare Advantage Plans Cost?

 

With a Medicare Advantage Plan, you must still pay your Part B  premium. 

 

Your out-of-pocket cost in a Medicare Advantage Plan depends on:

  • Monthly premium

  • Yearly deductible

  • Cost of each visit or service (copayments can be like $10 or $20

each time you see a doctor)

  • Type of services you need and how often you receive them

  • Does it include a Part D - Prescription Drug Plan

  • If HMO or PPO, do you use IN-NETWORK providers

  • Extra benefits the plan charges for

  • If you get extra help from your state or Medicaid

 

Most Medicare Advantage Plans have little to no monthly premiums, but all have copayments at the doctor and hospital.  The total cost of the premiums, copayments and deductibles is often less than the total costs for coinsurance, copayments and deductibles in Original Medicare.

 

Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services.  Once you reach this limit, you'll pay nothing for covered services.  This limit is different between Medicare Advantage Plans and can change

each year.

Each Medicare Advantage Plan charges different premiums and has different costs for services, so it is important to check these before you sign-up with a plan.

What Do Medicare Advantage Plans Cover?

 

Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you're in a Medicare Advantage Plan.

 

In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care.

 

The plan can choose not to cover the costs of services that aren't medically necessary under Medicare.  If you're not sure whether a service is covered or not, check with your provider before you get the service.

 

Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs.

 

Most include Medicare prescription drug coverage (Part D).  You will need to check to make sure that all of your prescriptions will be covered on the plans formulary list before enrolling in the plan.

Important things to

  remember about

Medicare Advantage Plans

 

  • You are still in the Medicare Program.

  • You still have Medicare rights and protections.

  • You still get complete Part A and Part B, they are just provided by the Medicare Advantage Plan.

  • You can only join a plan during certain times of the year; therefore, you are enrolled in the plan for one year.

  • You can join with a pre-existing condition, except End-Stage Renal Disease (ESRD).

  • You have to follow the plans rules; if an HMO you must use their network of doctors.

  • You cannot be charged more than Original Medicare for services like chemotherapy, dialysis and skilled nursing care.

  • You have a yearly limit on your out-of pocket costs for medical services.

  • If the plan decides to stop participating in Medicare, you can join another plan, go to a Medicare Supplement, or go back to Original Medicare.

  • You can NOT have both a Medicare Advantage Plan and a Medicare Supplement plan; it is illegal to have both.

 

 

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