Medicare Plan Part C (Advantage Plan)

Medicare Plan Part C, also known as Medicare Advantage Plan, is the combination of Part A and Part B. The main difference in Part C is that it is provided through private insurance companies approved by Medicare (HMOs and PPOs). With this Part C, you may have lower costs and receive extra benefits. Part C plans often have networks, and you must use the doctors or hospitals that belong to the plan. These plans help you coordinate and manage your overall care. Medicare Part C includes specialized care for people who need a large amount of health care services.

When you join a Medicare Advantage Plan, you will use the health insurance card that you get from the Advantage Plan for your health care. With a majority of these plans there are usually extra benefits and lower co-payments than in the Original Medicare Plan (Parts A & B). However, you will probably have to go to doctors that belong to the plan or get services only from certain hospitals.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. Also, you will probably have to pay a monthly premium to your Medicare Advantage Plan for the additional benefits that they provide.

If you do join a Medicare Advantage Plan, your Medigap policy won’t work. This means it won’t pay any deductibles, co-payments, or other cost-sharing under your Medicare Health Plan. That means that you will probably want to drop your Medigap policy if you join a Medicare Advantage Plan. However, you do have a legal right to keep your Medigap policy.

Which type of Medicare Advantage Plans (Part C) are available?

Medicare Health Maintenance Organizations (HMO) - With this plan you are only able to visit doctors that are in the HMO network. If you need to see a specialist, then you will have to get a referral.

Medicare Preferred Provider Organization (PPO) - If select this type of plan, then you can see any doctor or specialist that you choose. However, If they are not in your PPO network, your cost will increase. You are usually permitted to see a specialist without a referral.

Private Fee-for-Service (PFFS) - This plan allows you to see any doctor or specialist, but they must be willing to accept the PFFS's fees, terms, and conditions. If you need to see a specialist, you do not have to have a referral.

Medicare Special Needs - These plans were created for people with specific chronic diseases or other special health needs. These plans must include Part A, Part B, and Part D coverage.

Medical Savings Account (MSA) - The MSA has a high deductible plan that doesn't provide coverage until the annual deductible is met. It also requires a savings account plan where Medicare can deposit money for you to use for your health care costs.

Many Medicare Part C plans already include prescription drug coverage (Part D). If your plan offers drug coverage, you have to take it. If you have a stand-alone drug plan, and your Medicare Advantage Plan already has one, you will not be able to keep the Part C coverage. If you already have a prescription drug coverage, then you will probably want to select an Advantage Plan that does not have the drug plan included.

It is very important that you spend the time to research the different Medicare Advantage Plans that are available. You should check with your doctor and hospital to see if they are included in any of the HMO or PPO networks. By doing your research now, it will probably save you a lot of time and money later.