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Medicare
Advantage Insurance
(Part C)

Medicare Advantage Insurance (Part C)

 

Medicare Part C plans, also known as Medicare Advantage plans, are simply a “bundled alternative” to Original Medicare - meaning they include Medicare Part A (hospital coverage), Medicare Part B (medical insurance) and often Medicare Part D (drug coverage) equivalent coverage.  Additionally, most Medicare Advantage Plans may offer extra benefits beyond Original Medicare, such as dental, vision, hearing, health/wellness programs and more.

 

These alternative plans are offered by private insurance companies that have been approved and contracted by Medicare.  Medicare pays a fixed amount every month to the private insurance companies offering the Medicare Advantage plan. The insurance companies then use the money from Medicare to provide the coverage and benefits included within the Medicare Advantage plan.

Although the insurance companies must follow rules set by Medicare, each Medicare Advantage plan can vary.  For example, they can charge different out-of-pocket costs and have different rules for how you get services, like whether you need a referral to see a specialist or if you must go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care.

Since the Medicare Advantage plans out-of-pockets costs and providers can vary, it is important to understand that most Medicare Advantage plans will have a network (like and HMO or PPO) and will typically need to use health care providers who participate in the plan’s network. These plans set a yearly limit on what you will have to pay out-of-pocket – referred to as an “Annual Out-of-Pocket maximum” amount.

Additionally, the plans and costs are structured such that you do not need a Medicare Supplement (Medigap) plan.  In fact, it's illegal for an insurance company to sell you a Medicare Supplement plan if you have a Medicare Advantage plan.  (In other words, Medicare Supplement/Medigap plans only work with Original Medicare Parts A & B, not Part C.)

Many people often ask if Medicare Advantage plans are better than Original Medicare.  There is no simple answer to this question.  It is simply important to understand that both Original Medicare and Medicare advantage are different…and it is important to understand those differences and ultimately find out which plan will best meet your specific needs.

Medicare Advantage Pros:

 

  • Additional benefits, which may include some cost savings or subsidies toward hearing, dental and vision care.

  • Potentially lower premiums for coverage.

  • Limits on how much you may have to pay out of pocket for hospital and medical coverage.

Medicare Advantage Cons:

 

  • Less freedom to choose your medical providers.

  • Requirements that you reside and get your nonemergency medical care in the plan’s geographic service area.

  • Limits on your ability to switch back to Original Medicare with a Medicare Supplement Insurance policy.

  • The potential for the plan to end, either by the insurer or by the network and its included medical providers. (If this happens, you’ll be notified and offered other options.)

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