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A Medicare Advantage Plan, also known as Part C Medicare, is a health coverage option you may consider as part of Medicare. These Medicare Advantage Plans, which can include types like HMO or PPO, are offered by private companies approved by Medicare.
When you enroll in a Medicare Advantage Plan, it provides all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Regardless of the plan type, you will always be covered for emergency and urgent care services. It's important to note that Medicare Advantage Plans are required to cover all services included in Original Medicare, with the exception of hospice care, which is still covered by Original Medicare even if you participate in a Medicare Advantage Plan. Additionally, Medicare Advantage Plans are not deemed supplemental coverage.
These plans may also feature a Prescription Drug plan.
Alongside your Part B premium, you typically pay one monthly premium for the services covered under the Medicare Advantage Plan.
WHO CAN ENROLL IN MEDICARE PART C?
Generally, you can join a Medicare Advantage Plan if you meet the following criteria:
- You have both Part A and Part B coverage.
- You reside in the service area of the chosen plan; it's advisable to contact the plans of interest to confirm the service area.
- You do not have End-Stage Renal Disease (ESRD), which refers to permanent kidney failure that necessitates dialysis or a kidney transplant. A few exceptions for ESRD do apply, and for more information, TTY users can call 1-877-486-2048, available 24/7 or visit WWW.MEDICARE.GOV.
- If you have ALS (Amyotrophic Lateral Sclerosis, also known as Lou Gehrig’s disease), you automatically qualify for Part B starting the month your disability benefits commence.
Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans, also known as Part C Medicare. These companies must adhere to rules established by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have various guidelines for service access, such as whether you need a referral to see a specialist or if you must visit only doctors, facilities, or suppliers within the plan's network.
TYPES OF MEDICARE ADVANTAGE PLANS
Medicare Advantage Plans can include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans (PFFS), Point of Service (POS) Plans, Provider Sponsored Organizations (PSO), Medical Savings Account (MSA) Plans, and Special Needs Plans (SNP). Health Maintenance Organizations (HMO) are a type of Medicare Advantage Plan available in certain areas.
Plans must cover all Medicare Part A and Part B health care. Some HMOs may provide coverage for extra days in the hospital. Generally, within HMOs, you can only see doctors, specialists, or hospitals listed in the plan, except during emergencies. Your costs might be lower compared to Original Medicare. Preferred Provider Organizations (PPO) are another form of Medicare Advantage Plan that allows you to pay less if you use doctors, hospitals, and providers within the network, although you can access care outside the network for an additional fee.
Private Fee-for-Service Plans (PFFS) allow you to visit any Medicare-approved doctor or hospital willing to accept the plan’s payment. The insurance plan determines the payment amounts and what you'll pay for the services received. Depending on your coverage, costs for Medicare-covered benefits may vary. Medical Savings Accounts (MSA) consist of two parts: a high deductible health plan and a bank account, with Medicare contributing an annual amount for your health coverage.
Point of Service (POS) Plans are similar to HMOs but permit the use of doctors and hospitals outside the plan for an additional cost. Provider Sponsored Organizations (PSO) are plans managed by a provider or group of providers, frequently delivering care through the providers participating in the plan. Lastly, Special Needs Plans (SNP) cater to specific populations, offering more focused health care for individuals with both Medicare and Medicaid, those living in nursing homes, or those with specific chronic medical conditions.
By providing the information below, I grant permission for a licensed insurance agent, Gabriela Insurance, to call or email me regarding my health coverage options, including Medicare Advantage plans, Part C Medicare options, Medicare Supplement, and Prescription Drug Plans.
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By calling 818-856-3775 you will be connected with a licensed agent to discuss Medicare Advantage, Medicare Part D and/or Medicare Supplement Insurance plans. We do not offer every plan available in your area. Currently we represent 9 organizations which offer 68 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.