Medicare Part C isn’t really part of Medicare at all. Medicare Part C is actually when a private, Medicare-approved health insurance company takes over Medicare Part A and Medicare Part B from the Federal government and manages your healthcare in what is known as a Medicare Advantage Plan.
If You Decide to Join a Medicare Advantage Plan, You Are Still in the Medicare Program and Must Continue Paying Your Part B Premium
Medicare Advantage plans provide all of your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage. They generally offer additional benefits, such as vision, dental, and hearing, and many include prescription drug coverage. However, these private Medicare Advantage plans usually have networks that restrict which doctors you may see and what hospitals and other medical facilities may provide your care.
Medicare Advantage Plan Options Can Include:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plans (SNPs)
- HMO Point-of-Service (HMOPOS)
- Medical Savings Account (MSA)
Medigap vs Medicare Advantage Plans: A Few Tips
When people approach the age of 65, they start getting numerous mailings from the government and other private companies about their Medicare coverage options. If you have never read anything or dealt with Medicare in any capacity in the past, it would be like learning a new language. It is critical to make a good decision about your Medicare coverage since there are time limits and annual enrollment periods that restrict when you can opt into and start your Medicare coverage, your Medicare supplemental plan and Medicare drug (Part D) coverage.
When you qualify for Medicare, in most cases it will be age 65, the challenge is trying to understand your coverage gap and drug coverage options. You’ll have a choice of Medigap Plans and Medicare Advantage Plans. However, these two options have different price points and behave differently.
Before deciding to sign up for anything, especially a Medicare Advantage plan, it’s important to know the advantages and disadvantages of all your options. This is where a qualified independent Medicare Supplement agent can thoroughly explain all of the parameters to these plan options, such as provider networks, drug formularies and co-pays, etc.
Anyone who applies for a Medicare Advantage plan must discontinue using their Medicare Part A and Medicare Part B Insurance Coverage. You’ll still keep your original Medicare ID card; you just cannot use it, at least while you are covered by that Medicare Advantage plan.
To use a Medicare Advantage Plan, suspending your Medicare Part A and Medicare Part B is necessary, because it allows you to sign up with the private insurance company that is selling their particular Medicare Advantage plan. If the insurance company you signed up with dropped out of their Medicare Advantage contract, you would be dis-enrolled from that Medicare Advantage Plan. At that point you would only have 63 days to either sign up for an alternative Medicare Advantage plan or Medicare Supplemental plan. This is a rare occasion when you are dealing with large successful Medicare Advantage Companies such as UnitedHealthCare or Humana.
Most if not all Medicare Advantage plans have a well-defined provider network. This means that healthcare services will only be covered if they are performed by a doctor or clinic that is approved by the Medicare Advantage insurance company and is considered In-Network.
Medicare Advantage is often considered to be a Medicare replacement; It IS NOT a Medicare Supplement. Medicare Supplement Insurance; also referred to as Medigap Insurance, supplements original Medicare: that’s Medicare Part A and Part B.
Medicare Advantage, on the other hand, does not supplement existing Medicare. Instead, it replaces Medicare Part A and Part B insurance altogether. Please keep in mind that Medicare Advantage plans also contain gaps, so members are still responsible for paying various deductibles and co-pays, which vary from one Medicare advantage plan to the next.
The Only Way All of These Gaps in Medicare Coverage Can be Avoided is by Staying on Original Medicare Part A and Medicare Part B and Purchasing a Traditional Medicare Supplement Insurance Plan.
Medigap Plans work with Medicare Part A and Medicare Part B to fill and pay for coverage gaps. There are 10 different types of Medigap Plans that are standardized. The most popular one is Medigap Plan F. Plan F has absolutely no gaps at all.
Medicare Advantage Plans Do Not Have Standardized Benefits While Medigap Plans Do.
You could buy a Medigap Plan F from any insurance company doing business in your state, and it would have identical benefits nationwide, regardless of which company or how much you are paying for that Plan F. Advantage Plans have independent rules, limits and regulations, so you’ll need to read each plan summary separately. Medicare Advantage Plans offer the same coverage as original Medicare. However, just about every service on a Medicare Advantage Plan will have a copy or co-insurance connected to it.
You cannot combine an Advantage Plan with a Medigap Plan. Advantage Plans usually provide more benefits than original Medicare (often referred to as value-added benefits), but you’ll have to read the individual policy and summary for more details. Examples of value added benefits include some form of dental coverage, vision coverage, hearing coverage, gym memberships, etc.
Most, if not all Medicare Advantage plans have a network of doctors, clinics and hospitals. It may be either a PPO or HMO network. In HMO plans, you would need a referral to see a specialist. Hospitals, doctors and clinics can also drop out of any particular Medicare Advantage plan at their leisure, leaving you, the Medicare Advantage recipient, the possibility of having to pay out-of-network costs or possibly the full cost of care.
To determine which type of Medicare Supplement plan is the best fit for you, have a qualified, appointed and certified Independent Medicare Supplement Agent help you.
In October 2012 I met a 72 year old male client here in Palm Beach County, Florida. He had a history of kidney stones and went to his primary care physician, who was able to relieve the pain but it took 4 months before he was able to see the urology specialist, who was out-of-network and who was needed to resolve his particular situation with that kidney stone so it would not re-occur.
In 2015 I spoke to another client who was admitted to Jupiter Medical Center. Upon admission she was told that the hospital just dropped the Medicare Advantage plan she was then currently on.
Many Leading experts agree that Medicare Supplement Insurance is preferable to Medicare Advantage plans because you have the freedom to choose any doctor or hospital anywhere in the United States and no referrals are necessary. With the Medicare Supplement plan F, there are no deductibles, no co-payments, no claims forms and one monthly premium. There is 100% coverage with no remaining bills to pay if you purchase Medicare Plan F, as long as the procedure is covered by original Medicare.
For more information on how Florida Medicare Supplement Insurance can help with your health insurance needs call Neil Primack (561) 935-3907 or email him at: email@example.com.