Medicare Advantage (Part C)

What is Medicare Advantage?

Also known as Part C, Medicare Advantage plans are insurance programs that are administered by private carriers instead of through Original Medicare. To be eligible, you must:

A Medicare Advantage plan is a type of Medicare Insurance plan in which Medicare pays a private insurance company a nominal fee every month to manage your care for you. You still pay your Medicare premiums however Medicare is not be your primary insurance. Medicare Advantage plans (with names like HMO, PPO, PPF, etc.) typically include the prescription plan, Part D. When you have a Medicare Advantage plan you still have Medicare and still pay for it; however, it is not your primary insurance anymore. The Medicare Advantage carrier becomes your primary insurance.

Medicare Advantage plans must cover the same services Medicare covers, just at a different cost share. With these plans, you will typically pay co-payments (set amount) for many services, as opposed to Original Medicare’s co-insurance (percentage) for everything. They may also come with some extra bells and whistles that Medicare doesn’t cover and typically have a specific network of doctors you may see. Each carrier in your area may offer different doctor networks, benefits, and medicine formularies. Because of this, it is important to consult with a local Medicare Advisor that represents different carriers. It’s not one-size-fits-all.
Remember:

Medicare is paying a private carrier to manage your care for you. With a Medicare Advantage plan you show only your Medicare Advantage insurance card when you go to the doctor or pharmacy. You can even keep the Medicare card at home. Even though Medicare is not your primary, you still need to keep and pay for your Medicare Parts A and Part B.

Pros:

These plans come with low or even $0 premiums. Medicare Advantage plans also typically come with extra benefits not covered by Original Medicare, such as dental, vision, transportation, OTC products, and hearing aids.

Cons:

You must use carrier networks. Often, care must be received with in a certain geographical area. You will typically have co-payments for most services. If you want to switch to a Medicare Supplement in the future, you may need to go through Medical Underwriting.

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