Medicare Advantage - Part C

WHAT IS A MEDICARE ADVANTAGE PLAN?

Medicare Advantage Part C, or Medicare Advantage, insurance typically combines all types of Medicare coverage into a single health plan. Private insurance companies contracted by CMS to provide a Medicare benefits package as an alternative to Original Medicare provide it.


Medicare Advantage is optional, but in order to enroll in it, you must also have Original Medicare, Parts A and B. If you have a Medicare Advantage plan, you must also continue to pay your Part B payment. While Medicare Advantage plans must include all Medicare Part A and Part B benefits (excluding hospice care), plans can also include a variety of extra services that vary by private health insurer.


Prescription medication coverage is included in many Medicare Advantage plans. Some plans may have a lower deductible while also allowing you to pay a lesser percentage of the remaining charges. Medicare Advantage plans may even cover health-care treatments that Original Medicare, Parts A and B, do not cover, such as eye examinations, hearing aids, dental care, or health-care services acquired when traveling outside the United States.

WHAT DO MEDICARE ADVANTAGE PLANS COVER?

  • Dental Benefits
  • Vision Benefits
  • Hearing Aids
  • Foot Care
  • Telehealth & Virtual Services
  • Over the Counter benefits
  • Fitness Program
  • Worldwide Coverage for Emergency Care services
  • Prescription drug coverage (Medicare Part D)

How Is Medicare Advantage Different From Original Medicare?

Medicare Advantage Plans (Part C) include Parts A and B of Medicare, and many also provide prescription drug coverage (Part D) and other benefits not available under Original Medicare. As a result, roughly 26 million of the approximately 64 million people who applied for Medicare chose Medicare Advantage plans. 


Original Medicare consists of Parts A and B. Part A covers inpatient medical requirements such as hospitalization, home care, and other inpatient medical needs. Part B covers outpatient treatment, including doctor visits, medical testing, screenings, and preventive care.


Many individuals may require additional health-care coverage. Original Medicare does not cover prescription drugs. Private insurers offer Medicare Part D coverage, but there may still be areas of your healthcare where you want protection. This is where Medicare Advantage can fill that gap. 

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Medicare Advantage Plans We Offer

HMO

Health Maintenance Organization

Except for emergencies and out-of-area urgent care and dialysis, Medicare Advantage HMO plans do not allow as much provider freedom as a PPO. In rare situations, you may be permitted to utilize out-of-network providers, but you will be responsible for the entire cost of the services.


Under an HMO plan, you must select an in-network primary care physician (PCP) and obtain a recommendation for in-network specialist visits.

PPO

Preferred Provider Organization

Medicare Advantage PPO plans allow some provider freedom at a greater cost for those that need it.


PPO plans cover providers, physicians, and hospitals both in-network and out-of-network. You will pay less for in-network providers' services and more for out-of-network providers' services. A PPO plan does not require a referral of a primary care physician (PCP) for specialist appointments.

D-SNP

Dual Eligible Special Needs Plans

Dual Eligible Special Needs Plans (D-SNPs) enroll people who are eligible for both Medicare (Title XVIII) and Medicaid medical assistance (title XIX). Some Medicare expenditures are covered by states, depending on the state and the individual's eligibility.

Is A Medicare Advantage Plan Right For You?


YES


  • You’re enrolled in Original Medicare (Parts A and B).


  • You’d like to keep premiums and copays as low as possible.


  • You want to combine medical and prescription coverage in one easy plan.


  • You want benefits Original Medicare doesn’t cover, such as dental and vision.

NO


  • You’re enrolling separately in Medicare Part D for prescription drug coverage.


  • You have coverage from an employer that pays all or some of the costs that Original Medicare doesn’t cover.


  • You have coverage through your union that pays all or some of the costs that Original Medicare doesn’t cover.



Other Parts Of Medicare

Frequently Asked Questions About Medicare Advantage Part C

  • Who qualifies for the Medicare Advantage plan?

    Anyone who is enrolled in Original Medicare (Part A and Part B) may be eligible to sign up for a Medicare Advantage (Part C) plan. This includes people under the age of 65 who have qualified for Medicare because of a disability. 

  • When can you switch to a Medicare Advantage plan?

    There are 3 timeframes where you can switch to Medicare Advantage:  


    1. Inital Open Enrollment - generally lasts for 7 months from 3 months before the month you turn 65 to 3 months after the month you turn 65, unless you qualify for Medicare based on disability.


    2. Open Enrollment Period -occurs from October 15 to December 7 each year.


    3. Medicare Advantage Open Enrollment - lasts from January 1 through March 31 each year and is specifically for Medicare Advantage Plans.

  • Can you go back to Original Medicare from an Advantage plan?

    Yes.  However, there are 2 times during the year that this can be done:  1.  During Annual Open Enrollment from October 15 through December 7, and again during Medicare Advantage Open Enrollement from January 1 through March 31.

  • If I choose to cancel Medicare Advantage, who can I contact?

    There are 3 ways to switch back to Original Medicare during open enrollment period:


    1.  Visit your local Social Security Office and ask to be disenrolled from Medicare Advantage


    2.  Call 1-800-MEDICARE (1-800-633-4227) and process your disenrollment over the phone


    3.  Contact your Medicare Advantage insurer directly and request a disenrollment form.

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