Information on Medicare Plans and Medicare Health Insurance

Medicare Part C

You have a choice in Medicare Plan coverage. You do not have use traditional Medicare combination of plan A and plan B.

This is your choice:

  • The original Medicare Plan (Part A and Part B), or
  • Medicare Part C.

Medicare Advantage (MA) is Medicare Part C

Another name for Medicare Part C is the Medicare Advantage Plan. It is an advantage because you might be able to receive more coverage than the original plan provides.

In this article, the terms: Medicare Advantage, MA and Part C all mean the same thing and are often interchanged.

Medicare Part C Coverage

  1. Covers – Everything included in Part A and B.
  2. Does Not Cover – Hospice, which is still covered by Part A
  3. May Cover – Prescription drugs.
  4. May Have – Additional covered services.

Private Coverage

Medicare Advantage plans are offered through private insurance companies. These insurance companies are approved by CMS. As required by the Medicare Part C definition, Medicare C providers must cover all the services provided by both Part A (Hospital Insurance) and Part B (Medical Insurance).

There is an exception is for Hospice care. Hospice care is covered by Part A, regardless if you have a Medicare Advantage Plan.

Both plans (original Medicare and Medicare Part C) cover you for emergency and urgent care. The advantage is that Part C plans may offer extra coverage such as vision, hearing, dental, and/or health and wellness programs. Many plans include prescription coverage (Part D).

With Part C, you still have the same Medicare rights and protection as you do under parts A and B, including the right to appeal. Additionally, you can still join plan even if you have a pre-existing condition

If you are in a plan that includes prescription drug coverage, you should not try to join a Medicare Prescription Drug Plan (Part D). If you do, you will be removed from your Medicare Advantage Plan and returned to basic Medicare.

Medicare Supplemental Coverage

Medicare Advantage plans are not Medicare Supplement (Medigap) plans. However, they are similar to Medigap coverage in that the advantage plans may offer more coverage than the original Medicare. MA plans end the need for a Medicare Supplement Insurance policy.

A point of fact is that you cannot be legally sold Medigap coverage if you are enrolled in an Advantage Plan. Also, you cannot use Medigap to cover your MA Plan deductibles, co-payment, or co-insurance.

Medicare Advantage Plan Differences

Each Part C Medicare plan is different. They do not work in the same way. Each plan charges its own set of out-of-pocket cost. The rules for how you get services also differ by plan. For instance, you may need a referral to see a specialist in one plan and not the other.

Some plans may restrict you to go to only the doctors, facilities, or suppliers that belong to the plan. If you go to a doctor, facility, or supplier outside the plan, your services may not be covered, or may even cost you more.

There are many different types of MA plans. These plans include: Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee for Service (PFFS), Medical Savings Account (MSA) and Special Needs Plans (SNP). Less common plan types include: Point of Service (POS) and Providers Sponsored Organizations (PSO).

Medicare Part C plans require you to pay a monthly premium in addition to the part B monthly premium.

Choosing a Medicare Advantage Plan

There are many choices for MA plans. These are offered by private companies that are paid a set monthly fee from Medicare. Resources found online and those on top of this page can lead you to more information about Medicare Advantage Plans.