Chapter 5 - Medicare Part C Advantage Plans

Understanding Medicare Advantage Plans

An alternative to “Original Medicare” is a Medicare Advantage Plan, also called Part C. This allows you to “bundle” Medicare Part A and Part B into one plan. A Medicare Advantage Plan provides the coverage of Medicare, but it is offered by private companies and operates similar to traditional insurance. Medicare Advantage Plans have networks, like a PPO or HMO. Most Medicare Advantage Plans include Part D for prescription drug coverage. Some plans even include additional benefits such as dental and vision that are not covered by “Original Medicare”.

Eligibility, Cost and Renewal

In order to be eligible for a Medicare Advantage Plan, you must already be enrolled in Medicare Parts A and B. Each Advantage Plan sets the amounts for monthly premiums, deductibles, and your copay or coinsurance. Some Medicare Advantage Plans cover a portion of your Part B premium. Your copay or coinsurance may vary, depending on whether or not you use in-network providers . Medicare Advantage Plans must be renewed annually, and costs associated with your plan may change each year. 

Consider the Network

Different plans are affiliated with different networks of doctors. If you have a personal doctor or healthcare provider that you would like to continue using, make sure your provider works with the Medicare Advantage plan you choose.

Consider the Type of Plan

Each plan, like an HMO, PPO, HMO-POS, etc., has rules about how you receive services. Some require a referral for a specialist or have guidelines on what facility or provider you can use in a non-emergency situation. The plan will determine the type of services offered and how often you may receive them. Pay close attention to the type of plan you are considering. 

Other Rules to Consider

If you already have a Medicare Supplement Insurance plan, you cannot use a Medicare Advantage Plan. You must choose one or the other. Be aware, there may be penalties for changing plans. Please do your research and consult with your insurance agent before making a change. 

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