MEDICARE EDUCATION

Lesson 3: Medicare Advantage Plans

What is Medicare Part C?

Medicare Part C, or Medicare Advantage, is a plan offered by a private insurance company that bundles your Medicare Part A and Part B along with additional benefits. Most Medicare Advantage plans include your prescription drug coverage (Part D), along with other benefits your traditional Medicare Part A and Part B do not provide, like:

Gym / fitness club memberships
Vision coverage
Dental coverage
Hearing coverage
Various medical supplies

The private insurance companies determine the Medicare Advantage plans and options available in your state and county. Each year, private insurance companies can decide to join or leave Medicare. If a plan decides to stop offering Medicare Advantage plans, you must enroll in another private health plan or return to original (basic) Medicare coverage.

The Benefits of Medicare Advantage

In many cases, Medicare Advantage plans prove to be more beneficial than your basic Medicare plans. Some of the benefits may include:

More coverage options
Lower premiums
Lower copays
Yearly limits on out-of-pocket costs

If you are considering enrolling in Medicare Advantage, it's important to have all your options evaluated to determine if Medicare Advantage is the best option for you.

Medicare Advantage Networks

There are currently 2 types of Medicare Advantage (Part C) plans offered by private insurance companies.

1. HMO

An HMO (Health Maintenance Organization) is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. When you have an HMO, you generally must get your care and services from doctors, other health care providers, and hospitals in the plan’s network, with the exceptions of emergency care, out-of-area urgent care, and temporary out-of-area dialysis.

Some HMOs are Point-of-Service (HMOPOS) plans that may allow you to get some services out-ofnetwork for a higher copayment or coinsurance. It’s important that you follow the plan’s rules, like getting prior approval for a certain service (when required).

2. PPO

A PPO is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PPOs have networks of doctors, other health care providers, and hospitals. You pay less if you go to providers and facilities that belong to the plan’s network. You can generally go to out of network providers for covered services, but you’ll usually pay more.