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Medicare Advantage Part C Overview

Medicare Advantage (Medicare Part C)

Medicare Part C is also called Medicare Advantage. Medicare Advantage covers all benefits covered by Medicare Parts A and Part B and generally includes prescription drug coverage as well.

You have many options when choosing a Medicare Advantage plan. You can find a plan that provides the right combination of services for your situation.

You Have A Choice!

Medicare Advantage is different way to receive your Medicare coverage. You are not required to enroll in Part C but you MUST have Medicare parts A and B in order to enroll in a Medicare Advantage plan.

You make this choice based on your lifestyle, your health, and your budget.

Medicare Advantage Plans are health plan options that are approved by Medicare but run by private health care providers. Medicare Advantage Plans provide all Part A, Part B and (usually) Part D services to enrolled beneficiaries and MAY offer extra benefits like dental, vision and/or hearing. Although all medically necessary services provided by traditional Medicare must also be covered by Medicare Advantage, plans can charge different co-pays, co-insurance and deductibles, and may require the beneficiary to use a specific network of providers. That’s one big difference between original Medicare and Medicare Advantage.

Medicare Advantage Plans

There are many different types of Medicare Advantage plans offered by private insurance companies. They fall into three general categories.

  • HMO you must use a network of contracted providers
  • PPO Using network providers will provide the most cost savings but you can generally go out of network for an additional cost.
  • PFFS You can use any provider, any time, anywhere as long as the provider agrees to accept the plans payment, terms and conditions on each visit.

Out-Of-Pocket Costs

Medicare Advantage doesn’t cover the entire cost of the medical services you receive. Each plan explains the cost sharing in their “Summary of Benefits” and in more detail in their “Evidence of Coverage” that is updated every year. Since benefits may change every year, it is very important to read your “Annual Notice of Change” letter sent out in October of every year.

Some Medicare Part C plans charge an additional premium over and above your Medicare Part B premium. Many charge no additional premium at all. Medicare Advantage plans are filed with Medicare on a county by county basis. Neighboring counties can have benefits that are drastically different from each other. You can only enroll in a Medicare Advantage plan available in your county or service area.

If you choose original Medicare, there is no limit to your out-of-pocket expenses. However, with Medicare Advantage, Medicare sets a maximum out-of-pocket expense each calendar year. Many Medicare Advantage plans have out of pocket limits much lower than the Medicare maximum. This is one big advantage of Medicare Advantage plans over original Medicare if you have high medical expenses.

Next, let’s talk about Medicare Part D.