Medicare Part C

medicare-senior-56 Medicare Advantage plans “MA” (aka “Part C”) are Medicare-approved private insurance plans that enable you to choose an HMO or PPO Health insurance plan. These plans typically are simple, all-inclusive plans that include and provide all the benefits of Medicare A, B and usually D, as well as preventive health care benefits.

Additional benefits covered by “MA” that  the original Medicare doesn’t cover include: coverage while traveling outside the U.S.; long-term care; routine eye care; most dental care; dentures; hearing examinations; routine foot care; alternative medicine (acupuncture and chiropractic); long-term or custodial care; medical maintenance services; non-medical services such as in-room tv, telephone, and copies of x-rays; and the choice between HMO’s and PPO’s.

Medicare Advantage “MA”

The benefit of a Medicare Advantage plan is that you get to shop for the options and coverages that best serve you and the insurance provider takes care of the billing.

When shopping for Medicare Advantage plans “MA”  Part C, you need to verify if  your premiums are covered by Medicare based on you and your spouse meeting the 10-year  employment and contributing to Social Security requirements.  If you have met these requirements, your premium may be covered by Social Security.

Additional plan specifics that might impact your monthly premium are the following:

  • Deductibles
  • Copayment or Coinsurance
  • Using network or out-of network providers
  • Special benefits for extra needs
  • The plan’s out-of-pocket maximum of $6,700

*Keep in mind that Original Medicare has the “unknown factor” because it has a coinsurance of 20% no matter what that has no limit and no out of pocket maximum.  Therefore, the risk is the unknown medical costs that are out of your pocket with Medicare A and B, whereas Medicare Advantage costs are capped (limited).

Basic Plan Structure for Medicare Advantage

1.  An HMO plan:  Most insurance carriers coordinate your health care through a primary care physician within an organization that manages all of your medical needs from specialists to hospitals.

2.  A  PPO plan: Offers the flexibility to choose any physician, specialist or hospital of your choice.  However, if you choose a care provider who is within a network designated by the insurance carrier (“in network”), then you will pay less than if you choose a care provider who is “out of network” for that insurance company.

3.  Private Fee-For-Service (PFFS):  Medicare-approved doctors who provide care and accept the “Plans Payment Terms.”

4.  Special Needs Plan (SNP):  Provides insurance for specific diseases or characteristics.  For example, the plan could provide coverage if you have a severe or disabling chronic condition that might require you to live in an institution like a nursing home using dual insurances from Medicare & Medicaid.

5.  Medical Savings Plans (MSA):  Plans with high deductibles that are tied to a savings account.  Medicare will add money to the savings account, which will be used for your health services.

 

 

MedicareBenefits.us is not associated with the federal government. All plan information provided on this site is collected from public sources (e.g., cms.gov, carrier's website, plan brochures, etc.). Rates shown are for comparison purpose only. Contact your Medicare agent or Medicare.gov for a binding quote.