What is Medicare Advantage/Part C Coverage?

Medicare Advantage (MA) also referred to as Part C plans are private health plans that have contracts with Medicare. If enrolled, Medicare-covered healthcare services go through the private plan. Medicare Part C plans typically require the use of in-network providers that consist of doctors, hospitals, drug stores and other healthcare providers that the plans have contracts with. The use of providers outside the plan’s network can have additional costs or not be covered by Medicare.

What's included in Medicare Part C?

  • Medicare Part A (hospital services) and Part B (doctor’s visits)

  • Vision, dental, hearing and transportation services. (optional)

The costs are different from Original Medicare. Medicare Advantage plans may also cover prescription drugs. If offered, purchasing a separate Medicare prescription drug plan is not allowed.

Enrollment in Medicare Parts A and B is a requirement to join a Medicare Advantage plan. Part B premiums must be paid along with any additional premium that the plan may charge. The Part B premium usually comes out of Social Security checks automatically, confirm with the Medicare Advantage plans before deciding to enroll.

The different types of Medicare Advantage plans

Medicare Advantage plans come in a variety of types. There are 5 options for the type of MA plan available.

  1. Health Maintenance Organizations (HMOs) - If care is not received from an HMP approved provider, called an in-network provider, Medicare will not cover it. A referral is typically needed from a primary care provider to see a specialist.

  2. Medical Savings Accounts (MSAs) - A high deductible must be paid before the plan covers any benefits. A health savings account is linked to the plan and Medicare puts money in the savings account each year, but the amount is less than the annual deductible.

  3. Preferred Provider Organizations (PPOs) - Care from a Medicare provider out-of-network can be received, but the costs is higher for out-of-network care. Primary care doctor not needed.

  4. Private Fee-for-Service plans (PFFS) - There is no network of providers. Any Medicare provider who agrees to the plan’s terms and payments can be seen. Providers can decide on a case-by-case and visit-by-visit basis whether to see a Medicare beneficiary.

  5. Special Needs Plans (SNPs) - These are PPOs or HMOs that only admit people with Medicare who have certain conditions. Learn more.

Enrolling in both Medicare Advantage and Medigap (Supplemental insurance) is not allowed

If enrolled in a Medicare Advantage plan, purchasing a Medigap/supplemental insurance policy is not allowed. There are limited opportunities to switch from an MA plan to a Medigap policy + Original Medicare in the future there is a desire to switch back to Original Medicare.

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