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Learn About Medicare Part C
Medicare Advantage also known as Medicare Part C was introduced in the 1970s as a way to introduce private health plan options, and they have certainly grown in popularity over the years. The 1997 Balanced Budget Act established the Medicare+Choice program, which later transitioned into Medicare Advantage under the 2003 Medicare Modernization Act.
Today, Medicare Advantage (MA) plans offer beneficiaries a wide range of comprehensive coverage options beyond Original Medicare Part A and Part B. These MA plans have different benefit structures, including HMOs, PPOs, and SNPs, delivering enhanced benefits, care coordination, and potential cost savings.
What is Medicare Advantage?
Medicare Part B is for medical services outside of the hospital.
Prior to considering enrollment in Medicare Advantage plans, beneficiaries should be aware that Medicare Advantage is an alternative way to receive their Medicare benefits through private insurance companies approved by Medicare. Unlike Original Medicare, which is administered directly by the government, Medicare Advantage plans are offered by private insurers who contract with Medicare to provide all Part A and Part B benefits. This means that beneficiaries who choose Medicare Advantage must receive their healthcare services through the plan's network of providers, and they may have different rules, costs, and coverage limitations compared to Original Medicare. It is crucial for beneficiaries to carefully review and understand the plan benefits of each Medicare Advantage plan, including its network, costs, coverage, and additional benefits, to ensure it aligns with their healthcare needs and preferences.
Note.
Remember that you must be enrolled in Original Medicare Part A and Part B to be eligible for Medicare Advantage. You can apply for Medicare Part C -(Medicare Advantage) three months prior to your 65th birthday, or Part B effective date.
What are the Benefits of Medicare Part C?
All Medicare Advantage plans (Part C) offer you the same benefits as Original Medicare Part A and Part B, but this is just the beginning of what these types of plans can offer you. You'll find that most plans offered will have a very low and in most cases no premium to pay on a monthly basis. Keep in mind that you'll have to continue to pay the Medicare Part B monthly premium.
These types of Medicare plans are very attractive to seniors who are living on a fixed income, but it's important to remember and understand the out-of-pocket costs associated with healthcare services. Some basic services like a primary care office visit may not cost you anything, but a two night stay inpatient could be hundreds of dollars.
In addition to the basic benefits described above, most Medicare Advantage plans will include a prescription drug component, and in turn this means that you do not need to purchase a Medicare Part D plan. In fact you cannot do this as enrollment in another plan would cause termination of your current plan.
Remember that Medicare Advantage plans are designed and offered by private insurance companies, and each company that offers these plans will have additional benefits, like dental, vision & hearing, transportation and health club memberships to name a few. It's important to review these options with your agent to fully understand your financial responsibility of the plan benefits.
How do I join a Medicare Advantage plan?
Everyone who is new to Medicare, either by turning age 65 or signing up for Medicare for the first time will have an opportunity to enroll in a Medicare Advantage plan. There are in addition enrollment periods and timelines, the need to be enrolled in Medicare Part A and Part B. There is quite a bit of research to be done before making your decision, and in most cases there will be a very wide range of plans available in your area. This is where we can help you pick the best plan for you. We'll help you make sure that any doctors you see are in the plans network, and also help you understand the cost of your prescription medications.?
Is Medicare Advantage the same as Medigap Insurance?
In short they are not the same, however they are both viable options that deliver protection against high cost healthcare services. It's important to understand that Medigap insurance policies do not include Part D prescription drug coverage, and whereas Medicare Advantage in most cases will include prescription drug coverage. You'll find that most of the Medicare Advantage plan options are going to have a $0 monthly premium, whereas a Medigap plan could cost around $100 per month or more, depending on the plan type, your age and the state/county you live in.
We like to think of Medigap insurance as the most comprehensive coverage option which works hand in hand with Original Medicare. You can think of Medicare as an 80/20 plan. Your providers will bill Medicare directly and if the claim is approved it will pay approximately 80%, leaving you responsible for the other 20%. This is were a Medigap policy then pays most of the other 20%.
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Medicare Advantage Plans for Veterans
Many of those that have served our country have access to medical care through the US Veterans Affairs (VA). The VA Health Benefits packages provide many basic healthcare services including, Routine Health Exams, Immunization, Surgeries, Medical Treatments and access to prescription drugs, and access to emergency and urgent care that may be available at some VA Health Facilities.
The VA clearly states that any veteran should sign up for full Medicare benefits when first eligible. In most cases this will happen when you are turning age 65. The reason being that the VA is funded by the federal government, and each year Congress must approve adequate funding so that all veterans receive the care they need. Unfortunately, there is no crystal ball when it comes to Federal Funding and if you are in a lower priority group, at some point in the future you may be denied care because of this.
If you delay signing up for Medicare Part B when first eligible, you may have to wait until January of the following year to get enrolled again. In addition, you'll face the possibility of Medicare late enrollment penalties which will last the lifetime of the beneficiary.
Veterans have an option to enroll in Medicare Part A and Part B only, of can greatly benefit from a Medicare Advantage plan.
A Medicare Advantage (MA) plans provide comprehensive healthcare coverage, often including services beyond what traditional Medicare offers. This means that veterans can access a wide range of medical services, such as preventive care, hospital stays, prescription drugs, and specialist visits, all under one plan. This comprehensive coverage can be particularly advantageous for veterans who may require specialized care for service-related injuries or conditions.
Secondly, Medicare Advantage plans often offer additional benefits that can enhance the overall healthcare experience for veterans. These benefits may include dental, vision, and hearing coverage, which are not typically covered under traditional Medicare. As many veterans may have specific healthcare needs related to their military service, such additional benefits can greatly improve their quality of life. Additionally, Medicare Advantage plans often provide access to wellness programs, gym memberships, and telehealth services, which can be particularly beneficial for veterans who may have mobility issues or live in remote areas. These extra benefits can help veterans maintain their health, manage chronic conditions, and receive timely and convenient care.
Questions & Answers
There are enrollment periods when it comes to Medicare Advantage plan changes. The most common is the Annual Enrollment Period (AEP) when beneficiaries can select a different plan for the following year. You can also make a one time change to your Medicare Advantage plan in the Open Enrollment Period which begins each January through February. There are also circumstances where the plan you enrolled in did not live up to it's stated benefits, or you were mislead and Medicare may grant you an opportunity to return to Original Medicare or switch to another Advantage Plan.
You'll have the option to enroll, change or move to another Medicare Advantage plan during the Annual Enrollment Period (AEP) each year. Starting October 15th and ending on December 7th, there is pleaty of time to review your current insurnace coverage and determine if you need to make a change for the following year. Outside of the AEP, there are other opportunitities to join, change or disenroll from your Medicare Advantage plan. These are refered to as Special Election Periods (SEP). You'll need the advice of an insurance producer to determine if you would be eligible for this to happen.
No, just like Original Medicare, each beneficiary has their own individual coverage. If your spouse is eligible for Medicare, they can enroll in their own Medicare Advantage plan. The same is true for Part D prescription and Medicare Supplement insurance.
You'll find that the majority of Medicare Advantage plans have a $0 monthly premium. How can that be, you may ask? In an effort to minimize the administrative task of running health insurance programs, the Federal Government pays private insurance companies a fee for every member that they enroll in a Medicare Advantage plan. This is a very lucrative proposition for the insurer and decreases the burden on the Medicare system as a whole.
Yes you can! Medicare is available to any US legal person who is 65 years old. However, if your spouse has not worked at least ten years and paid Medicare taxes, then you could be subject to a Part A premium adjustment. There are also people younger than 65 with certain disabilities that may qualify for Medicare.
Medicare can be confusing for most. We want to help you navigate the many options available to you, so please call us directly at (800) 405-4802 and chat with our insurance advisors for help.
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