Hopefully you’ve already learned about Medicare A, B, and D in our previous posts, but if you haven’t it would be a great idea to read those before continuing with Part C as it’s sort of a prerequisite (no dessert until you’ve finished your dinner). You can click here for Part A, here for Part B, and here for Part D. Come on back and read all about Part C when you’re done.
Welcome back! Time for that promised dessert – Medicare Part C!
Bonus Tip: Original Medicare (Parts A & B) are administered and regulated by the federal government (via the Centers for Medicare and Medicaid Services – CMS), and Medicare Parts D (prescription drug coverage) and C (Medicare Advantage Plans) are administered by private insurance companies and regulated by CMS.
What exactly is Medicare Part C?
It is a means of obtaining health care coverage through comprehensive healthcare plans offered by private insurance carriers. Medicare Part C, referred to as Medicare Advantage Plans, provides hospital and medical coverage and can also include drug coverage for a handy all-in-one way of receiving health benefits. There are lots of different companies offering a wide selection of plans that can vary significantly. All plans, however, must provide coverage equal to that of original Medicare. They can provide more coverage, but not less. In other words, there is no need to worry that if you sign up for a Medicare Advantage Plan you might compromise your coverage under original Medicare. Instead, these plans cover the same medically necessary services as Medicare but with added benefits (such as dental, vision, hearing, fitness memberships, over-the-counter credits, transportation, chiropractic care, healthy food cards, meal delivery, and more).
Bonus Tip: If you enroll in a Medicare Advantage Plan you will get an insurance card from the plan to show to providers instead of your Medicare Card. Don’t throw out your red, white, and blue Medicare card though because you may need it in the future.
Who Qualifies for Medicare Advantage (Part C) Plans?
In order to qualify for any Medicare Advantage Plan you must:
- Have Medicare Parts A and B
- Live in the plans service area (these plans vary from county to county)
- Continue to pay your Part B premium while enrolled in the plan
How Much Will a Medicare Advantage Plan Cost?
The costs associated with a Medicare Advantage Plan vary from plan to plan and include:
- Monthly Premium if applicable -- many plans have $0 premiums (don’t forget you must continue to pay your Part B premium while enrolled in Medicare Advantage Plan).
- Copays – these are amounts (set by the plan) you will be responsible for paying for covered services you receive and can differ from one plan to another.
- Coinsurance – some services, as well as some covered items (prescription drugs, durable medical equipment, chemotherapy, etc.) require you to pay a percentage of the total cost.
- Deductibles – some plans have amounts set that you must pay before the plan’s coverage will begin.
Bonus Tip: Even if a plan has a deductible, you may never have to pay it. This is because most drug deductibles don’t apply to tiers 1 & 2 of the drug formularies (you know what tiers and drug formularies are because you read our previous post about Part D, right?). If not you can read it here. Also, medical deductibles often do not apply when you use in network providers to obtain services.
What Types of Medicare Advantage Plans Are There?
There are several types of plans and I’ll link you to more detailed information at the end of this post. For now, here’s a list and a shorthand description of each:
- PPO – Preferred Provider Organization – has a network of service area providers but allows for in network and out-of-network coverage (usually at a higher cost to you) and usually does not require referrals to see specialists.
- HMO – Health Maintenance Organization – has a network of service area providers you must use and sometimes requires referrals to see specialists.
- PFFS – Private Fee For Service – allows you to use any provider who agrees to see you and accepts the plans’ terms of payment (sometimes has a network of providers and also offers out of network coverage, but at a higher cost to you). No referral necessary to see specialists.
- MSA – Medicare Savings Account – these plans deposit a sum of money into a special savings account for you to use to pay for services before your deductible is met, don’t require referrals, and sometimes have a network. If the plan doesn’t include drug coverage you will have to enroll in a standalone drug plan.
- SNP – Special Needs Plans – these plans are special plans for people with specific needs such as health conditions or limited income. These plans can be quite beneficial to qualifying medicare beneficiaries as they are specially tailored to these specific needs.
Bonus Tip: Find an honest, independent agent who specializes in helping people with Medicare insurance options to assist you in this undertaking. These people have lots of experience and knowledge that can make the process of choosing the most suitable plan for your particular situation much, much easier. They can also tell you about extra benefits included in various plans which could save you money on things you already use. It isn’t uncommon for an Advantage Plan member to find out after spending money on something that they could have gotten it through their plan at no cost. It also truly pays to have your own personal agent in your corner and on speed dial to call directly with questions or concerns.
WHEN CHOOSING A PLAN BE SURE TO...
- Verify that your doctors are in the plan’s network before enrolling in a plan!
- Make sure the prescriptions you take are covered under the plan’s drug formulary and your copays will be affordable.
- Review the Summary of Benefits prior to enrolling in a plan.
- Remember that plans can change from year to year so it’s important to review and compare options annually.
Bonus Tip: Your plan will send you an Annual Notice of Change informing you of any changes to your plan – READ IT! Or better yet, schedule a review with a licensed independent agent during Annual Enrollment Period (AEP) between October 15 and December 7 so you can make sure the plan you have is still the best choice for you for the coming year.
WORD TO THE WISE:
If you speak with an agent about Medicare Advantage Plans (in person or over the phone) and he/she does not ask you what doctors you see or offer to ensure your drugs are covered in the plan’s formulary, consider that a red flag. No agent should ever enroll you into any plan without first making sure that you will be able to continue to see your doctors and afford your prescriptions.
PROTECT YOURSELF FROM FRAUD/SCAMS/IDENTITY THEFT – JUST HANG UP!
- Medicare does not call you! That caller saying they work for or with Medicare is not someone you should talk to. Hang up and call Medicare directly. You could even jot down the number and report it if you want to help put an end to these scams.
- Social Security does not call you! If someone is claiming they’re calling from Social Security hang up! If you’re still concerned you can call Social Security directly.
- Medicaid does not call you (unless you’ve requested a call back or have a phone interview appointment scheduled). If you get a call from someone claiming they are from Medicaid, hang up! Again, you can call them directly if you’re worried.
Knowledge is power and you can help stop the growing problem of Medicare fraud, waste, and abuse by exercising the power of hanging up the phone!