Medicare Part C, also known as a Medicare Advantage Plan, is not a Medicare Supplement Plan. It is a private alternative to Original Medicare. If you have a Medicare Advantage Plan, you will still pay your Medicare Part B deductible, and that premium will go to the insurance company. This is why they are very little or no premiums to this type of plan. Coverage in a Medicare Advantage Plan does not work like a Medicare Supplement. Medicare Advantage does not cover the 20% that Medicare does not cover. Medicare Advantage Plans will replace what Medicare Parts A and B would normally charge with their own set of co-insurance, co-pays, and deductibles.
When a Medicare Advantage Plan replaces your Medicare, you will not be able to go to any doctor or hospital that you choose or that may accept Original Medicare. Almost all Medicare Advantage Plans (HMO plans) have a network of doctors and hospitals that you can choose from, however some plans such as PPO type plans do allow you to choose any doctor or hospital that you want however, you will have to pay more for those services. The following is a breakdown of how a Medicare Advantage Plan works:
• Low monthly premium. Many plans have zero premiums. Remember that there are no such thing as a zero-premium plans. 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.
• They do require 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.
• You do 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 those services.
• Medicare Advantage Plans have a max-out-of-pocket for your protection. Once you have paid a specific amount (usually $6700.00), 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 where you are out of network are around $10,000.00 depending on which doctors and hospitals you visit.
• Many plans have dental, vision, hearing and even a fitness membership which is normally Silver Sneakers. 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. Normally you will not be able to choose a separate Part D plan.
What is nice about a Medicare Advantage Plan is that these plans can protect you from the 20% that Medicare doesn’t pay with an annual maximum of out pocket.
If you have any questions regarding Medicare, it’s coverage or its plans, please give our office a call at 1-877-997-9830 or visit our website at MyMedicareQuotes.com
By Joe DeAngelis
Medicare Supplement Advisory services