Medicare Advantage (Part C)
Making sense of Medicare Advantage Plans
Original Medicare consists of two parts; Part A which is Hospital coverage, and Part B which is Medical coverage. However, having Original Medicare alone may leave you with significant out-of-pocket expenses as it was never intended to cover all your medical costs. Fortunately, one way to offset your medical expenses is through a Medicare Advantage Plan.
Medicare Advantage plans, also referred to as Part C, are Medicare health plans that provide hospital, medical, and sometimes prescription drug coverage under one plan. They are offered through private insurance companies and replace your Original Medicare. Now, you will still have your Original Medicare in the background and continue to pay your Part B premium, but you will only use your Advantage plan when receiving hospital or medical services.
Additionally, Advantage plan premiums start out at $0 per month but vary from carrier to carrier. Some Advantage plans may even offer a benefit that lowers your Part B premium. Since these plans operate off a network like an HMO or PPO, you will have a network of doctors to choose from. If your doctor is not in the network, you may have to pay a higher copay with a PPO plan or completely out of pocket for the visit with an HMO plan. Unless it is an emergency or urgently needed service, out-of-network providers can deny care.
Moreover, you may have a deductible for your health costs, after which you will have a set copay/coinsurance on health care services. All plans have an annual cap called a Maximum Out-of-Pocket (MOOP); the MOOP is the most you pay for copays, coinsurance, and other costs for medical services for the year. Some services such as prescription copays, dental, and vision do not apply.
When it comes to the prescription coverage, a separate deductible may apply for prescription drugs. There are copays/coinsurances for covered drugs and a network of pharmacies to choose from.
Aside from the hospital, medical and prescription coverage included in these plans, they may also offer additional benefits not covered by Medicare like routine dental, vision, and hearing. These additional benefits may be included at no additional cost or the plan may have an option to add it on as an optional supplemental benefit for an additional premium.
Lastly, to enroll in a Medicare Advantage plan, you must be enrolled in Original Medicare and live in the plan’s service area. There are certain times of the year when you may enroll in or change your Advantage plan, one of them being the Annual Enrollment Period (AEP) which is October 15th– December 7th of each year. In addition to AEP, there is the Medicare Advantage Open Enrollment Period (MA OEP) which runs from January 1st to March 31st, where you can change your Advantage plan or drop it completely and go back to Original Medicare if you are unhappy. Otherwise, you must have a Special Election Period to pick up these plans.
Since each Medicare Advantage plan has different provider networks, set copays/coinsurances, premiums, etc. it can be difficult to choose the right that meets your needs. Below we have included an example of how plan benefits can vary across companies.
[Pabst, M. (n.d.). How to pick the right Medicare Advantage plan. Aetna. https://www.aetnamedicare.com/en/understanding-medicare/plan-comparison-tool.html.]
This is the type of work your AMAC Medicare Advisor can do for you. We take your specific needs and concerns into consideration when sifting through the plethora of plans being offered.
For help with Medicare plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or request a call below!
