MEDICARE PART C

Medicare Advantage

Medicare Annual Enrollment Period (AEP)

        October 15 – December 7

Medicare Advantage (often referred to as Part C) plans are an alternative way for beneficiaries to receive their Medicare benefits. Instead of receiving benefits directly through Original Medicare (Parts A and B), beneficiaries can choose to receive them through a private insurance company that offers a Medicare Advantage plan. Here are some key points to understand about Medicare Advantage:

  • Coverage: All Medicare Advantage plans must provide at least the same level of coverage as Original Medicare (Part A and Part B). Many also offer additional benefits not covered by Original Medicare, such as:
    • Vision care
    • Hearing care
    • Dental care
    • Wellness programs
    • Prescription drug coverage (similar to what’s offered under Medicare Part D)

Types of Medicare Advantage Plans:

There are several types, including:

    • Health Maintenance Organization (HMO): In HMOs, beneficiaries typically choose a primary care physician and may need referrals for specialists. They might pay more if they see doctors outside of the plan’s network.
    • Preferred Provider Organization (PPO): PPOs have a network of doctors, but beneficiaries can go outside of the network for a higher fee.
    • Private Fee-for-Service (PFFS): These plans determine how much they’ll pay doctors and how much the patient will pay when getting care.
    • Special Needs Plans (SNP): SNPs are tailored for people with specific conditions or circumstances.
    • There are other types as well, like HMO Point-of-Service (HMOPOS) and Medical Savings Account (MSA) plans.
  • Costs: Beneficiaries usually pay a monthly premium for the Medicare Advantage plan, in addition to the Part B premium. Costs can vary widely between plans, regions, and the level of benefits provided.
  • Network Restrictions: Some Medicare Advantage plans have network restrictions, meaning beneficiaries might pay more or might not be covered at all if they see providers outside of the plan’s network.
  • Enrollment: To enroll in a Medicare Advantage plan, a person must already have Medicare Part A and Part B and live in the plan’s service area.
  • Annual Election Period: Every year, there’s an annual election period (often referred to as “open enrollment”) during which beneficiaries can switch between Medicare Advantage plans, return to Original Medicare, or make other changes to their coverage.
  • Original Medicare vs. Medicare Advantage: One of the main differences between Original Medicare and Medicare Advantage is the way medical bills are paid and processed. With Original Medicare, the federal government pays for Medicare benefits directly. With Medicare Advantage, the federal government pays private insurance companies to manage and provide the benefits.

When considering a Medicare Advantage plan, it’s important to review the plan’s coverage details, costs, network restrictions, and any additional benefits. This helps ensure that the plan meets individual health care needs and budget considerations.