MEDICARE PART C – The Advantage Plan & How Does It Work?

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A Medicare Advantage Plan, like an HMO or PPO, is another choice you have as part of Medicare. The Medicare Advantage Plans, also called “Part C” or “MA Plans” are offered and administered by private insurance companies approved by Medicare.

A Medicare Advantage Plan will provide your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Some Advantage Plans may offer extra coverage, such as vision, hearing, dental, and wellness programs. Most do include prescription drug coverage, the Part D.
What happens is, Medicare pays a fixed amount for your care every month to the company offering your Advantage Plan. The company must follow the rules set by Medicare. However, each Advantage Plan can charge different out-of-pocket costs and have different rules for how you get your services.

For example: do you need a referral to see a specialist or which doctors, facilities, or suppliers you go to for non-urgent care. And, these rules can change each year.

It's important to review the differences between the types of Advantage plans to see which works best for you. There are different types of Advantage plans and the three most popular types are:
• HMO – Health Maintenance Organization: lets you see doctors and other health professionals who participate in its network. If your doctor is already on the network, it could be a good option because you tend to pay less out-of-pocket with in-network physicians.
• PPO – Preferred Provider Organization: Covers both in- and out-of-network providers, giving you the freedom to choose any doctor that accepts Medicare assignment, which can work if you prefer that kind of flexibility.
• FFS – Fee-for-Service plan: Here, the method determines how much it will pay your doctors and how much you must pay when you get care. Your doctor must accept the plan’s payment terms and agree to treat you. If the physician doesn’t agree to those terms, then the FFS plan will not cover services through that doctor

Now, you do remain enrolled in Original Medicare even if you are in an Advantage plan. Which means you must continue paying your Part B premiums in addition to your Advantage plan premiums. Also, if you do enroll in an Advantage plan, you will not be allowed to obtain a Medicare Supplement plan to cover the deductibles, copays and coinsurance costs of your Advantage plan. These are all out-of-pocket costs to you!

What do you do now? Simple! As a qualified broker, we specialize in Original Medicare and helping you with your Medicare supplement and drug plans. We have both the professional knowledge, experience, and follow-up to help you find the right options for you. Call us today at 1-800-825-2919.
Or, if you prefer – send us an email to [email protected].

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MEDICARE PART C – The Advantage Plan & How Does It Work?

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