Medicare Advantage Plans – Medicare Part C

Medicare Advantage Plans are offered by private companies approved by Medicare. A Medicare Advantage Plan is quite different than a Medicare Supplement Insurance (Medigap) policy since they replace original Medicare and primarily provides your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage. Most also cover vision, hearing, and dental coverage. Medicare pays these private companies to provide your Medicare benefits.

Who can avail a Medicare Advantage Plan?

You must first have both Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage and live in the area covered by the plan you want to join. If you have the End-Stage Renal Disease (ESRD), you will not be able to avail a Medicare Advantage Plan coverage.

Do I need to pay for a Medicare Advantage Plan?

There is a monthly premium for the services provided by your Medicare Advantage Plan. This is in addition to your monthly Medicare Part B premiums and Medicare Part A premiums if you haven’t availed the premium-free Part A. Medicare Advantage Plan monthly premiums costs differ depending on your private insurance provider and the benefits and coverage your plan contains.

Medicare Advantage plans have a mandatory maximum out-of-pocket limit (MOOP) of $6,700 for 2018 although many plans have much lower. Once you reach this amount, you wouldn’t need to pay anything for your covered health care expenses for the rest of the year.

Types of Medicare Advantage Plans

  • Health Maintenance Organization (HMO)
    Except in an urgent or emergency situation, this type of health insurance plan that usually limits the care coverage you can get from a network of doctors, hospitals, and other healthcare professionals.
  • Preferred Provider Organization (PPO)
    Similar to an HMO, there is a network of doctors, hospitals, and other healthcare professionals where you can get your care coverage. You are allowed to get care3 from providers outside the network but you have to pay more.
  • Private Fee-for-Service (PFFS)
    This plan is similar to original Medicare where you can avail care from any doctors, hospitals, and healthcare professionals as long as they accept your plans’ payment terms, rules, and policies.
  • Special Needs Plans (SNPs)
    SNPs are designed specifically to tailor to specific diseases or characteristics. They limit membership to people with the same illness, situation or condition.
  • HMO Point-of-Service (HMOPOS)
    This plan is typically a combination of an HMO and a PPO but in this, you'll need to choose a primary care physician (PCP) to coordinate all your care. You also have different deductibles for the HMO part and the POS part.
  • Medical Savings Account (MSA)
    An MSA is like a health savings account (HSA) where there is an account you can get money to cover any additional medical expenses. The main difference between an MSA and an HSA is that with a Medical Savings Account (MSA) your plan is the one who puts money in the account and not you. This means that any funds getting into this account comes from Medicare which in turn is being put into your account by your plan’s provider. You only have to choose a high deductible plan for this to work and pay only for your Medicare Part B premiums under Medical Savings Account (MSA) Plan. You can use the money to help fund or pay your health care services under your deductibles and other related expenses. Whatever is left at the end of the years will be added on top of your next year’s funds.

Just remember that Medicare Advantage Plans replace the original Medicare. It does not provide you with comprehensive coverage. You still have to pay a lot of out-of-pocket costs and expenses. You may be saving on monthly premiums but your other expenses would be far much greater than your supposed savings. Don’t wait to find yourself in a difficult situation first before shelling out a little more for monthly premiums that would ensure you a comprehensive coverage.
Medicare and in turn Medicare Advantage Plans only cover a portion of your healthcare expenses so make sure to have a supplement to completely fill in the “gaps” left by it. You can search for available Medicare Supplement Plans on our website that would give you the coverage and benefits you want and need. You can also call us at (855) 230-0801 for more information and assistance in finding the policy that suits you best.


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