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Medicare Part C

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Medicare Part C

Medicare Advantage (Medicare Part C) is the private health insurance alternative to the federally run original Medicare. Think of Advantage as a kind of one-stop-shopping choice that combines various parts of Medicare into one plan.

What is a Medicare Advantage Plan?

Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow the rules set by Medicare.

If you decide on a Medicare Advantage — or MA — plan, you’ll still have to enroll in parts A and B and pay the Part B premium. Then, in addition, you will have to choose a Medicare Advantage plan and sign up with a private insurer.

Most Medicare Advantage Plans include drug coverage (Part D). Not all of these plans cover the same extra benefits, so make sure to read the plan descriptions carefully.

What are the most common types of Medicare Advantage Plans?

In HMO Plans, you generally must get your care and services from providers in the plan's network, except:

  • Emergency care
  • Out-of-area urgent care
  • Out-of-area dialysis

In some plans, you may be able to go out-of-network for certain services. But, it usually costs less if you get your care from a network provider. This is called an HMO with a point-of-service (POS) option.

A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PPO Plans have network doctors, other health care providers, and hospitals. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network.

A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.  

Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. 

Are you eligible for Medicare Advantage Plans?

You qualify for Medicare Advantage Plan (Medicare Part C) if you already have Medicare parts A and B and if you live in the service area of the Medicare Part C provider you are considering.

In 2021, people with end-stage renal disease (ESRD) were eligible to enroll in a broader range of Medicare Advantage plans due to a law passed by Congress.

Benefits of Medicare Advantage Plans

Original Medicare only offers two types of coverage: hospital insurance and medical insurance. If you want additional coverage, you’ll need to purchase Medicare Part D for prescription drug coverage and Medigap for supplemental coverage.

With a Medicare Advantage plan, all your coverage options are in one convenient plan.

Medicare Advantage offers different plan types for your personal situation. For example, if you have a chronic health condition, an SNP Advantage plan can help with your medical costs.

If you prefer provider freedom, a PPO or PFFS plan may be more of what you’re looking for. If you want extra services like dental, vision, or hearing, many Medicare Advantage plans include them.

Many Advantage plans have no premiums and offer low or no deductibles. Another advantage of choosing Medicare Advantage is that most plans set limits on the maximum out-of-pocket costs you’ll pay during a plan year.

Also Researches has shown that you may save money on laboratory services and medical equipment by switching to a Medicare Advantage plan. If you choose a Medicare HMO plan, you may see even more savings on healthcare services provided by your HMO network.

Many Medicare Advantage plans include coordinated medical care. This means that your healthcare providers actively communicate to coordinate your care between different types of healthcare services and medical specialties. This ensures you have a healthcare team and helps avoid unnecessary expense and issues like medication interactions.

In one study, researchers found that coordinated care was associated with higher patient ratings and more positive medical staff experiences.

How much does a Medicare Advantage Plan cost?

The cost of a Medicare Advantage Plan plan will depend on a variety of factors. The most common costs within your plan will be:

  • Your Part B monthly premium, which may be covered by your Part C plan
  • Your Medicare Part C costs, which include a deductible and monthly premiums
  • Your out-of-pocket costs, which include co-payments and coinsurance

Medicare Advantage Plan FAQs

Original Medicare only offers two types of coverage: hospital insurance and medical insurance. If you want additional coverage, you’ll need to purchase Medicare Part D for prescription drug coverage and Medigap for supplemental coverage.

With a Medicare Advantage plan, all your coverage options are in one convenient plan.

Medicare Advantage offers different plan types for your personal situation. For example, if you have a chronic health condition, an SNP Advantage plan can help with your medical costs.

If you prefer provider freedom, a PPO or PFFS plan may be more of what you’re looking for. If you want extra services like dental, vision, or hearing, many Medicare Advantage plans include them.

Many Advantage plans have no premiums and offer low or no deductibles. Another advantage of choosing Medicare Advantage is that most plans set limits on the maximum out-of-pocket costs you’ll pay during a plan year.

Also Researches has shown that you may save money on laboratory services and medical equipment by switching to a Medicare Advantage plan. If you choose a Medicare HMO plan, you may see even more savings on healthcare services provided by your HMO network.

Many Medicare Advantage plans include coordinated medical care. This means that your healthcare providers actively communicate to coordinate your care between different types of healthcare services and medical specialties. This ensures you have a healthcare team and helps avoid unnecessary expense and issues like medication interactions.

In one study, researchers found that coordinated care was associated with higher patient ratings and more positive medical staff experiences.

Medicare overall is not easy to understand, and you need to consider a lot of factors before finalizing which one is the right fit for you. Our experts can help guide you. Talk to us today to learn more.

Already have Medicare Part C? Switching is easy

It might be time to switch insurers whenever the service that your existing insurer provides doesn’t meet your needs. For example, if you have a poor claims experience or an unexplained rate increase, it might be time to consider other options

If you cancel a previous policy before a new policy is effective, you could run into some serious financial problems.

Contact us today to help you with multiple options to choose from.

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