Part C
A Medicare Advantage plan is a private health insurance plan approved by Medicare. You may opt to get your Part A and B (some include Part D) benefits from a Medicare Advantage plan instead of traditional Medicare. Originally called Part C, these Medicare private insurance plans usually have an HMO or PPO network of doctors.
Medicare Advantage plans were created as an alternative to Original Medicare and Medigap. By joining one of these plans, you direct Medicare to pay these private companies a set monthly amount for your Advantage plan. In return, the plan will deliver all of your Part A & Part B services and most include Part D. These private companies take on all of your medical risk at that point.
With a Medicare Advantage plan, you will use the plan’s network of providers, which is usually local (by your zip code.) You will pay co-payments when you receive healthcare services. Each plan sets its own cost-sharing. For example, you might pay a small copay for a primary care doctor visit, and perhaps a higher copay to see a specialist. Likewise, you may have co-pays for different procedures, tests, and/or labs. Advantage plan benefits may change every year. In September, you will receive a packet from your Part C insurance company telling you what is changing. The plan’s benefits, formulary, pharmacy network, provider network, premium and/or co-payments and co-insurance may change on January 1 of each year. Another good reason to have an agent on your side.
You must continue to pay your Medicare Part B premium while enrolled in an Advantage plan. You must be enrolled in both Medicare Parts A and B and live in the plan’s service area.
One “advantage” about Medicare Advantage plans is that some of them offer minor benefits for routine dental, vision or hearing. Some plans even include gym memberships.
The Annual Election Period in the fall is the most common time to change your Medicare Advantage plan. This period runs from October 15th – December 7th each fall. Changes made to your enrollment will take effect January 1 the following year.
It is in your interest to enroll in Medicare Advantage through an insurance agent who can fully explain how the plan works. Enrolling without an agent means you are on your own if problems occur on the back end of your policy.
Come enjoy a cup of coffee and let us explain your Medicare options.
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