Medicare Part C, Medicare Advantage Plan

Medicare Part C is commonly known as Medicare Advantage and is run by private insurance companies. Enrolled medicare beneficiaries receive the same Medicare Part A and Part B coverage that original Medicare provides. Boomers in Medicare Advantage plans are still under Medicare but have chosen to receive their care through a private insurance company. According to the rules, Part C should provide equal coverage to regular Part A and Part B. However, some plans may cover more or less than Parts A and B ( Original Medicare ). Generally, they offer additional benefits and many include prescription drug coverage (Part D). Each plan will have different monthly premiums and different out-of-pocket costs allowing Medicare Advantage plans to generally save people money. However, your costs will vary depending on the type of plan you choose.

Some examples of Part C plans are:

Preferred Provider Organization (PPO )- With a PPO you pay less if you use doctors and hospitals that belong to the company's network and more if you use health care providers outside of the network.

Health Maintenance Organization (HMO )- You can only go to doctors and hospitals on the plan's list, except in an emergency. You may also need to get referrals from your primary care doctor to see a specialist.

Private Fee-For-Service (PFFS )- These plans aren't the same as Original Medicare, these plans determine how much it will pay doctors and hospitals, and how much you must pay when you get there. You will only have to pay the copayment or coinsurance amount allowed by the plan for the type of service you get at the time of service.

Special Needs Plans (SNP) – With a SNP membership is limited to people with specific diseases or characteristics, and are customized to their benefits, providers choices, and drug coverage to best meet the needs of the group. All SNPs must provide prescription drug coverage.

Medical Savings Account (MSA) – MSAs combine a high-deductible insurance plan with a medical savings account that can be used to help pay for your healthcare costs.

Medicare Advantage plans are all different, some have a network and will require you to go to certain Doctors and Hospitals within their network.  Just make sure to discuss all your needs with your insurance agent and make sure that you are getting the coverage that is best for you as you can only change your plan once a year during the Open Enrollment Period. People that are just turning 65 do not need to enroll in AEP and can join a Part C plan during an initial enrollment window.

Medicare Advantage Plans started off as Medicare+Choice thanks to the Balanced Budget Act of 1997. When the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was passed it changed the business practices of Part C and gave birth to the current Medicare Advantage plan. Studies show that the plan has grown in popularity over the years and in 2010 approximately 11.1 Million medicare beneficiaries were enrolled in the plan which makes up approximately 25% of the entire Medicare beneficiary pool. Posted in:

Medicare Part C, Medicare Advantage Plan