What Is a Medicare Advantage Plan (Medicare Part C)?

By planmedicare1 - March 10, 2016

As a Medicare beneficiary, you can choose from different Medicare options. One option is a Medicare Advantage Plan also known as Medicare Part C, or MAs/MA-PDs. Medicare Advantage plans are medical insurance plans offered by private companies, approved by Medicare, that offer the same benefits as Original Medicare and may provide additional benefits like vision, dental coverage, hearing benefits, health and wellness programs (Silver Sneakers), and some prescription drug coverage.

There are different types of Medicare Advantage plans to choose from. Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNP), and Medicare Medical Savings Account Plans (MSA).

Medicare Advantage Plans differ from one another in a few ways such as:

  • The network of doctors available.
  • The amount of out-of-pocket costs that the individual will be responsible for paying.
  • Referral requisition for certain specialists.

The basic components of Medicare Advantage (MA) plans are as follows:

  • Medicare pays a fixed amount for an individual’s care each month to the private insurance company providing your Medicare Advantage plan.
  • These private insurance companies must follow rules set by Medicare, one of which is that a Medicare Advantage plan must provide enrollees with the same benefits they would receive under Original Medicare. (Medicare Part A including hospital stays, skilled nursing care, and home health care. Part B including doctor visits, outpatient care, screenings, shots, and tests).
  • Individuals are responsible for paying your regular monthly Part B monthly premium in addition to the Medicare Advantage (Part C) – plan premium.
  • Individuals who enroll in a Medicare Advantage Plan cannot have a Medicare Supplement Policy.

The benefits of Medicare Advantage plans are as follows:

  • The advantage plan combines Parts A, B, and D into one plan with one Medicare ID Card.
  • The total cost of the deductibles, premiums and co-pays that an individual will pay using an Advantage plan is often lowerthan the total cost for those same expenses under Original Medicare.

The Medicare Program rates all health and prescription drug plans each year, based on the plan’s quality and performance.  A plan can get a rating between 1 and 5 stars (5 stars indicating the best possible service). These stars allow you to easily compare plans based on quality and performance, and they are updated every year (typically in the fall).

 If you are considering switching to a Medicare Advantage (Part C) plan from Original Medicare you should be aware of these important facts:

  • Advantage Plans are annual contracts, so a Medicare Advantage plan can change its benefits, increase costs or decide not to renew their contracts at the end of each year.
  • There are low (sometimes $0) monthly premiums.
  • Additional benefits not offered by original Medicare, such as dental and vision, are typically included in an Advantage Plan.

When deciding on which Medicare Advantage plan to choose, you should consider speaking with a local Medicare agent to answer the following questions:

  1. Are my doctors covered as In-Network providers?
  2. Do I need a referral to see a specialist?
  3. What happens if I want to go to a doctor outside the network?
  4. What are the costs (copays, deductibles) associated with services provided in the summary of benefits by the plan?
  5. Does the plan offer drug coverage? What tier do my drugs fall into and what are the copays associated with them?
  6. What additional benefits are offered by this plan?

If you have any questions in regards to Medicare Advantage Plans or if you are interested in purchasing one today please contact a trusted advisor at PlanMedicare.com

About Plan Medicare
Located in Melville, New York, Plan Medicare is a consulting agency formed to aid in understanding the many facets of Medicare.  Plan Medicare helps determine eligibility, clarify options and assist in the enrollment process.  Representatives are available 365 days a year to answer questions on payments, billing, policy, updates and changes and enrolling in new plans and policies. The health care landscape is constantly changing, it can be confusing and frustrating to try to figure out what kind of plan will work best.  Assistance is available, however. We make Medicare easy.

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