Medicare Advantage

Medicare Part C is one of the many options extended to Medicare beneficiaries. It is a primary plan that is sometimes mistaken for Medigap, the supplemental health insurance provided by Medicare. With its wide variety of plan types, Medicare can be confusing. However, a solid understanding of available benefits will allow Medicare beneficiaries to save substantial amounts of money on healthcare costs.

The Medicare Advantage Plan, also known as Medicare Part C, is a primary plan alternative that replaces separate Part B and Part A coverage and merges the beneficial aspects of the two. Medicare Part B generally covers visits to the doctor; Medicare Part A provides durable medical equipment and hospital coverage. Insuring a variety of medically necessary services, the Medicare Advantage Plan also covers prescription medications. Part C is dispensed by private insurance companies that are Medicare-approved.

The health plans that comprise Medicare Part C often include networks of participating hospitals and physicians. In addition, the Medicare Advantage Plan offers individualized services for Medicare patients who require frequent medical procedures. In cases of emergency, the beneficiary’s coverage may be extended outside of the normal coverage jurisdiction.

Medicare Part C includes the following health plan options:

• Health Maintenance Organization (HMO) - The beneficiary’s health needs may only be met by participating providers in the HMO network.

• Special Needs Plans- These options are only intended for patients suffering from chronic disease.

• Preferred Provider Organization (PPO) – The patient can elect to be seen by any doctor, but if the physician is outside of the PPO network, the beneficiary may be responsible for further costs.

• Private Fee-for-Service - The patient is covered regardless of which physician they choose to see, and no referral is necessary. The beneficiary must, however, agree to the associated terms and fees.

• Medical Savings Account (MSA) – The MSA plans are comprised of two options. The first coverage plan doesn’t begin until the annual deductible has been fully met. In the second plan, the Medicare organization saves funds in a patient account to apply to outstanding medical costs.

Medicare Part C is not a Medigap supplemental program. It is a form of primary coverage that provides various insurance options to participating beneficiaries.