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What is Medicare Advantage – Medicare Part C: Medicare Advantage Plans Explained

Medicare Part C is also known as a Medicare Advantage Plan, and it is not a Medicare Supplement Plan. It is a private alternative to Medicare. If you have a Medicare Advantage Plan, your Medicare Part B premium will go to the carrier that you have your plan with instead of Medicare and this is why there are very low or zero premium plans. As far as coverage, the Medicare Advantage does not work like a Medicare Supplement. It does not cover the 20% that Medicare does not cover. Medicare Advantage Plans replace what Medicare Parts A and B would charge with their own set of co-pays, deductibles and co-insurance.

Because Medicare Advantage Plans replace your Medicare, you can no longer go to any doctor or hospital that you choose. Most Medicare Advantage Plans (HMO plans) have a network of doctors and hospitals that you must choose from, however some plans such as PPO plans will allow you to choose any doctor or hospital that you want but you will have to pay more for their services. Here is a breakdown of how the average Medicare Advantage Plan works:

Low monthly premium. Some plans have zero premium. Just remember that there is no such thing as a zero-premium plan. The premium that you would normally pay to your Medicare Part B now goes to the carrier that you have your Medicare Advantage Plan with.
Requires you to pay some bills when you use the Plan. You will have co-pays, co-insurance and sometimes a deductible. Some plans will not have co-pays and some will, it all depends on the carrier you choose and the area you live in because these plans coverage differs in every state even if it’s with the same carrier.

You have to go to certain Doctors, Hospitals and other Providers. HMO plans have strict networks of doctors and hospitals and PPO plans allow you to see doctors and go to hospitals outside of your network, however you will pay more for the services.
Has a max-out-of-pocket for your protection. Once you have paid a certain amount, the plan will pay the rest of your healthcare cost. For 2019, the average HMO’s max-out-of-pocket is around $6,700.00 and the PPO Plans are around $10,000.00 depending on whether you use doctors and hospitals inside or outside of your network.

Sometimes included added benefits like dental, vision, hearing and even a gym membership. However, keep in mind that these plans do not have to keep these benefits because Medicare does not cover these services so these plans are not required to cover them.

Some of these plans will include Medicare Part D coverage in the plan and some will not.
What is nice about a Medicare Advantage Plan is that they protect you from the 20% that Medicare doesn’t pay with an annual maximum of out pocket. Again, the national average maximum of pocket for an HMO plan is going to be around $6,700 and around $10,000 for a PPO plan.

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