Medicare 101

What does Medicare Part C, aka Medicare Advantage, cover?


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Medicare Advantage Plans (like HMOs or PPOs) provide your Part A and Part B coverage and many times offer additional benefits. Private insurance companies approved by Medicare run these plans. Generally, you must see doctors within the network in the plan.

Who can join a Medicare Advantage Plan?

You must have Medicare Parts A and B and live in the plan’s service area to be eligible to join. People with End-Stage Renal Disease (permanent kidney failure) generally can’t join a Medicare Advantage Plan.

How much do Medicare Advantage Plans cost?

In addition to your Part B premium, you usually pay one monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join. Depending on the region, premiums can range from $0 monthly premium to hundreds of dollars. They all have a different annual maximum out of pocket figure that can be as high as $6,700. Be sure to pay attention to this as different plans can differ by thousands of dollars.

Most Medicare Advantage Plans include Medicare prescription drug coverage
(Part D). In addition to your Part B premium, you usually pay one monthly premium for the plan’s medical and prescription drug coverage.

What do Medicare Advantage Plans cover?

Medicare Advantage Plans must cover all of the services that Original Medicare covers except for hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area, but not outside the U.S. Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs like Silver Sneakers. Some also offer transportation, podiatry, chiropractic treatments and other ancillary services.

Advantages and Disadvantages

In a nutshell, Medicare Advantage plans offer a complete healthcare coverage, including a drug plan as part of an HMO. This means you will go to your primary care doctor in the first instance for all of your referrals to specialists. HMOs do care about cost and therefore will always ensure you need the treatment before allowing it. This is what is called the “gatekeeper” model. In short, the advantage is that it is less expensive than Medicare Supplement plans. The disadvantage is that you will have less control and flexibility in your healthcare.

Plan benefits can change from year to year. Make sure you understand how a plan works before you join.

Have any questions?
Just get in touch with one of our Heroes that would be happy to help you! We are unbiased independent brokers contracted with all of the major health insurance companies. We are 100% free to you and the prices are the same as if you went directly to the health insurance companies, but with us as your Medicare concierge we can continue to guide you in your journey.

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