About Medicare Advantage Plans: Part C

When it comes to Medicare, the federal health insurance program, there are quite a few plans, parts and combinations from which to choose.

One option is a Medicare Advantage (MA) plan – Part C.

What is Medicare Advantage?

Medicare Advantage plans are required to incorporate all of Original Medicare’s benefits. Many, but not all, include additional coverage options such as vision, dental and hearing. Some also incorporate fitness and wellness components.

These plans normally include Part A, Part B and sometimes, Part D.

As with all Medicare-related health plans, there are enrollment and disenrollment periods, differences in coverage and eligibility criteria, and varying costs.

Key Characteristics of Medicare Advantage

• Offered by private companies in accordance with Medicare rules
• Generally, services are rendered through a provider network
• May be required to use a specific network depending on the plan
• May include Part D Prescription Drug Plan
• You’ll pay your Part B premium and possibly a premium for the Medicare Advantage plan

Can I join a Part C plan?

If you meet the following criteria, yes, you can.

• Have Original Medicare Part A and Part B
• Live in the plan’s service area; and
• Be a United States citizen or lawfully in the country.

Note: While people with pre-existing conditions typically can join a Medicare Advantage plan, those with End Stage Renal Disease (ESRD) may not participate except in certain circumstances, such as developing ESRD after joining a MA plan.

Various Medicare Advantage options

There are, in fact, six different MA plans outlined in the Medicare & You 2018 Handbook.

• HMO – Generally requires members to use a primary care doctor and obtain referrals for specialists; if a doctor leaves the network, you can choose another physician within the network. Covers prescription drugs in most cases. May have to pay full cost of services not in the network.
• PPO – Has a network of physicians and hospitals; does not require a referral for a specialist and allows out-of-network care for covered services, though typically at a higher cost.
• Private Fee for Service (PFFS) plans allow members to go to any Medicare-approved physician or hospital agreeing to treat you and accept the plan’s terms of payment
• Special Needs Plans (SNP) are limited to people in facilities such as nursing homes, who need home nursing care, or have certain chronic diseases. Generally requires use of network except in some emergency situations; must include Part D drug coverage
• HMO Point of Service (HMOPOS) allowing some out of network services, often at a higher cost
• Medical Saving Account (MSA) combining a high-deductible healthcare plan with a bank account; no Part D coverage

If you are already on a Medicare Advantage plan, AmeriLife urges you to pay particular attention to both the evidence of coverage and annual notice of change sent to you by your plan. Together, these will give you information on what the plan covers and what you pay, as well as any changes going into effect in January of each year.

Various Medicare Advantage options

There are, in fact, six different MA plans outlined in the Medicare & You 2018 Handbook.

• HMO – Generally requires members to use a primary care doctor and obtain referrals for specialists; if a doctor leaves the network, you can choose another physician within the network. Covers prescription drugs in most cases. May have to pay full cost of services not in the network.
• PPO – Has a network of physicians and hospitals; does not require a referral for a specialist and allows out-of-network care for covered services, though typically at a higher cost.
• Private Fee for Service (PFFS) plans allow members to go to any Medicare-approved physician or hospital agreeing to treat you and accept the plan’s terms of payment
• Special Needs Plans (SNP) are limited to people in facilities such as nursing homes, who need home nursing care, or have certain chronic diseases. Generally requires use of network except in some emergency situations; must include Part D drug coverage
• HMO Point of Service (HMOPOS) allowing some out of network services, often at a higher cost
• Medical Saving Account (MSA) combining a high-deductible healthcare plan with a bank account; no Part D coverage

If you are already on a Medicare Advantage plan, AmeriLife urges you to pay particular attention to both the evidence of coverage and annual notice of change sent to you by your plan. Together, these will give you information on what the plan covers and what you pay, as well as any changes going into effect in January of each year.

Choosing Part C

Are you still working and have coverage under an employer group health plan? If so, and you sign up for a Medicare Advantage plan, you could lose your own and your family’s benefits under the employer plan. Keep in mind if you give up your employer coverage, you may not be able to resume it if you decide you do not want Medicare Advantage.

Some other things to know about Medicare Advantage are:

You are able to check with your plan to see if the service you want is covered, and what it will cost

• Many plans offer extra coverage like vision, hearing, dental, health and fitness programs
• Yearly limits apply on out-of-pocket costs for medical services. Once reached, you do not have to pay for covered services. These annual limits vary by plan, so review your options carefully.

Keep in mind you cannot purchase Medicare Advantage coverage if you have Medicare Supplement Insurance, also known as Medigap. In fact, it is against the law for someone to sell you a Medigap policy if you are on a Medicare Advantage plan, unless you are switching back to Original Medicare. Learn more

Choosing Part C

Are you still working and have coverage under an employer group health plan? If so, and you sign up for a Medicare Advantage plan, you could lose your own and your family’s benefits under the employer plan. Keep in mind if you give up your employer coverage, you may not be able to resume it if you decide you do not want Medicare Advantage.

Some other things to know about Medicare Advantage are:

You are able to check with your plan to see if the service you want is covered, and what it will cost

• Many plans offer extra coverage like vision, hearing, dental, health and fitness programs
• Yearly limits apply on out-of-pocket costs for medical services. Once reached, you do not have to pay for covered services. These annual limits vary by plan, so review your options carefully.

Keep in mind you cannot purchase Medicare Advantage coverage if you have Medicare Supplement Insurance, also known as Medigap. In fact, it is against the law for someone to sell you a Medigap policy if you are on a Medicare Advantage plan, unless you are switching back to Original Medicare. Learn more

Changing a Medicare Advantage plan

Once you enroll in a Medicare Advantage plan during the Medicare Initial Enrollment Period (IEP), you may only change during certain times of the year, including the Annual Enrollment Period Oct. 15 through Dec. 7 of each year.

During the January 1 – February 14 disenrollment period, if you are in a Medicare Advantage plan, you may switch back to Original Medicare and join a Prescription Drug Plan (Part D), with coverage starting the first day of the month following receipt of the enrollment request.

During this window of time, you may NOT:

• Switch from Original Medicare to a Medicare Advantage plan;
• Change MA plans;
• Change PDPs; and
• Enroll in, change or leave a Medicare MSA plan.

Similarly, MA plan providers can change plan services and payment levels once a year – or pull out of the Medicare program altogether.

You can often get prescription drug coverage through a Medicare Advantage plan. However, a member in a Medicare Advantage HMO or PPO who joins a separate drug plan will be disenrolled from the MA plan and go back to Original Medicare.

We understand Medicare

With a half-century in the senior market, AmeriLife has considerable experience with the Medicare program.

You do not have to do this alone.

One of our agents would be happy to sit down with you to review your options and answer your questions. Connect with an agent

We understand Medicare

With a half-century in the senior market, AmeriLife has considerable experience with the Medicare program.

You do not have to do this alone.

One of our agents would be happy to sit down with you to review your options and answer your questions. Connect with an agent