Medicare Advantage Plans

Medicare Part C, also known as Medicare Advantage plans, are some of the most comprehensive insurance plans that you can get when you are on Medicare insurance. Medicare is a program that is available to Americans over the age of 65, but it has a lot of gaps in coverage. When you become eligible for Medicare, you get to choose between enrolling with Medicare Part A, Medicare Part B, or both.  When you enroll with both Medicare Part A insurance and Medicare Part B insurance, it is known as Original Medicare insurance.  Another option to consider is opting for Medicare Advantage Plan and getting all of your Medicare coverage from a private insurance provider.  A private insurance provider is in contract with the Government run program Medicare.  Medicare actually monitors and regulates all of the private insurance companies.  So, with that being said, you can usually trust all of these private insurance companies offering senior health insurance.

Medicare Advantage Plans and Shopping Around Online

There are a few things you need to know before buying health insurance from private insurance companies.  You see, all plans that private insurance companies offer, or sell, to the public is standardized.  You will find that many of these private insurance companies offer different senior health insurance plans.  Some of these senior health insurance plans include: Medicare Advantage Plans, Medicare Part D Prescription Drug Plans, and Medigap Plans (also know as Medicare Supplemental insurance Plans).  But regardless of where you purchase these plans from, the amount of coverage and benefits that come with the plan are exactly the same.  They are standardized.  What is not standardizes however, is the price.  All private insurance providers are able to put their own price on the plans that they offer.  This is why shopping around online is beneficial if you are looking to save money.  Now, shopping around online is not exactly an easy task considering all of the private insurance companies out there offering senior health insurance.  So when doing so, it is important to take your time when going through the shopping process.

What are Medicare Advantage Plans?

Medicare Advantage plans, or Medicare Part C plans,  are a type of insurance plan that aims to combine all of the coverage that you would expect to get from Medicare Part A and Part B. With Medicare Part A, you get basic hospital coverage and Medicare Part B provides you with basic medical coverage. Under most circumstances, Medicare Part A comes for free from the Government.  This is called ”Premium Free Part A”.  Most seniors receive “Premium Free Part A” because themselves or their spouse paid Medicare taxes while working.   Medicare Part B insurance on the other hand, comes with a minimal premium payment.  Starting in 2013, the monthly premium amount for Medicare Part B is $104.90.  If you instead elect to go with Medicare Part C insurance, you should know that you do not get Medicare Part A or B, and get all your coverage from a private company.  You see, The Medicare program will pay part of your monthly premium since you are not getting any coverage from the Medicare program directly.

What do Medicare Advantage Plans cover?

A Medicare Advantage Plan usually covers everything that Original Medicare covers, but with some differences. Those differences can be in how much you pay out of your own pocket when you receive health care. For instance, you may have lower co payments or a smaller deductible, or you may be required to pay a different percent share of the bill (coinsurance).

However, all Medicare Advantage Plans coverage includes emergency care and urgent care. Some plans may even include additional coverage for routine vision, routine dental and/or wellness programs.  Also, most Medicare Advantage Plans also include prescription drug coverage under Medicare Part D. You should keep in mind however, Medicare Advantage Plans coverage do not include hospice care; that benefit remains with Original Medicare even if you have a Medicare Advantage Plan.

What are the different Medicare Advantage Plans?

Different types of Medicare Advantage Plans include:

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)

There are other less common types of Medicare Advantage Plans that may be available:

  • HMO Point of Service (HMOPOS) Plans: An HMO Plan that may allow you to get some services out-of-network for a higher cost.
  • Medical Savings Account (MSA) Plans: A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.

Eligibility for Medicare Advantage Plans

Medicare Advantage Plans eligibility is based on your membership in or eligibility for Medicare Parts A and B (except if you have End Stage Renal Disease (ESRD)). Usually, if you have Medicare Parts A and B, you are automatically eligible for Medicare Part C, or a Medicare Advantage Plan. However, there re usually requirements.  For instance, you must live in the service area for the Medicare Advantage Plan that you’re considering enrolling with. The service areas may be more limited than Original Medicare.

Medicare Supplemental Insurance

With Medicare Advantage plans, you get a combination of coverage options from multiple sections of Medicare. However, there is a chance that you may still not have all of the coverage areas that you need with this type of policy. If this is the case, you can get additional areas of coverage by paying for a Medicare supplemental insurance policy. A Medicare supplement, or Medigap is a smaller type of policy designed to fill in the gaps that come with Medicare. Some of these gaps include not being 100 percent covered.  Medicare Supplemental insurance helps cover these gaps by offering additional coverage.  With Medicare Supplemental insurance, you are able to be 100 percent covered.  However, these Medicare Supplement policies come with an additional premium, but some of them can provide some real benefits that you would not be able to get otherwise.

Getting the Help You Need

If you are about to qualify for Medicare insurance, you need to make sure that you get the right coverage options for you. Do not be left out in the dark with a basic Medicare Part A plan, when you need a lot more. Call 1-800-MEDIGAP to get all of your questions answered.