What is Medicare Advantage (Part C)?

Medicare Advantage is a program which allows you to enroll in private health insurance that offers both Medicare Part A and Medicate Part B benefits. Medicare Advantage plans are not supplemental insurance, but rather health insurance plans of their own. Medicare Advantage can also include prescription drug coverage in addition to vision, hearing, and dental. In most cases, you can join Medicare Advantage, even if you have been diagnosed with a pre-existing condition, except for final stage renal disease. Medicare Advantage plans must follow guidelines established by Medicare but also vary in terms of costs and rules.

 

Medicare Advantage Payments and Enrollment?

Most Medicare Advantage plans have lower co-payments than the traditional Medicare plans, but are also limited to certain service areas and often involve networks. You can only enroll in a Medicare Advantage plan during certain times of the year, but you will remain enrolled in most Medicate Advantage plans for a year. The amount that you pay yourself varies from Medicare Advantage plan to Medicare Advantage plan, so it is necessary to compare Medicare Advantage plans in order to find the plan most suitable to your needs. You can enroll in Medicare Advantage plans in paper, by telephone, or by an online Medicare Advantage application.

 

What are my Medicare Advantage Options?

Health Maintenance Organization (HMO) Medicare Advantage plans are required to cover both Medicare Part A and Medicare B health care, but can also offer additional benefits. You will only be able to visit physicians and hospitals that are within the HMO network unless there is an emergency. However, HMO's can lower costs, making them (in some cases) a less expensive option to the traditional Medicare plan.

 

Preferred Provider Organizations (PPOs) Medicare Advantage plans allow you to use doctors, hospitals, and specialists within the PPO network. However, you are permitted to use health providers outside of the network at an additional cost to you without a referral.

 

With a Private Fee for Service (PFFS) Medicare Advantage plan, you are able to use any doctor or specialist, so long as they accept the terms, fees, and conditions of the Medicare Advantage PFFS. The Medicare Advantage plan chooses how much it will pay for the services, and you can spend more or less on PFFS Medicare Advantage plans than on the traditional Medicare plans.

 

Medicare Special Needs (MSA) plans are limited to people with certain diseases, disabilities, or other health needs and are customized to fit the needs of that specific group, including people who have diabetes. Medical Special Needs Medicare Advantage plans continually include the Medicare Part D prescription medication insurance.

 

In a Medical Savings Account (MSA) Medicare Advantage plan you do not pay a monthly premium because you have a high deductible. You must pay the Medicare Part B premium, and must also pay for Medicare covered services, and after you reach the deductible, the Medicare Advantage plan will pay for Medicare services. You will also have a savings account in which Medicare will deposit money for your health care costs. MSA Medicare Advantage plans do not include prescription drugs.

 

Are there any risks and what if I'm not satisfied?

No matter what Medicare Advantage plan you choose, you will be protected and covered by Medicare Part A and Medicare Part B. If you are not satisfied with your Medicare Advantage plan, you can enroll in the traditional Medicare program. If the Medicare Advantage plan provider opts to end its involvement with Medicare, you will need to choose another Medicare Advantage plan or enroll in traditional Medicare.