What is Medicare Part C - Advantage?
Written by Andrea L. Corbin
We have had Medicare Parts A – Hospital and Medicare Part B – Medical coverage for over 40 years. Now we have Medicare Part D – Prescription coverage. But what happened to Part C?
Although Part C was introduced with the same Bill that brought about Medicare Part D, we have heard very little about it.
 Medicare Part C coverage is called Advantage. The Government knows that Medicare will need help with all the baby boomers headed for Medicare eligibility. To provide that help, the Medicare Reform Bill of 2003 brought to the table new choices in how you can receive your Medicare benefits. Medicare is now contracting with private insurance companies to provide benefits equal to or better than what Medicare can do. Medicare provides the funding for most of the coverage and the insurance companies are responsible for handling all the administration, paperwork, processing and paying the bills for all of Medicare A & B coverage. The insurance companies can add things like routine physicals and other benefits to their offerings. For Medicare Advantage C participants this can mean lower premiums and more benefits.
There are currently four different options available, from restrictive to non-restrictive open access plans. The open access plans allow you to use any provider (doctors, hospitals, etc.) that accepts Medicare fee structures and accepts the payment terms and conditions of the insurance company. There are usually no contracts required with the doctors and no restrictions on the care beyond those of Medicare. These plans are called Private Fee for Service (PFFS) plans and most doctors are willing to work with these types of plans – so you generally do not need to change doctors, you don’t need referrals or prior approvals for Medicare provided care. You always need be check with your provider to be sure they accept your PFFS plan.
The second type of Advantage plan is the PPO or Preferred Provider Organization. With these plans, there is list of preferred Providers and if you use them you will have the best and/or lease expensive coverage. You can go out of the system but there are usually penalties like higher co-
pays when you do. You do not need referrals or approvals for Medicare provided care.
The third type is the HMO. This type of plan has been around for a long time and requires that you choose a primary care physician from an approved provider list. Your Primary Care Physician will coordinate your care with specialists and hospital care. With the HMO’s you do need referrals to see the specialists or receive most hospital care. This is the most restrictive of all the Advantage plans.
The forth type is an MSA. This works in a similar way to the HSA plans for pre-Medicare coverage. You have a Medical Savings Account to cover the higher deductibles and higher co-pays of your health coverage. These plans usually have low or no premium. You put money in a Savings account each month instead of paying a premium. When you have bills, you have saved for it. The health portion of these plans can be set up as HMO, PPO, or PFFS.
All the advantage plans usually have some form of co-pays for care received and usually provide extra benefits for helping you stay health such as routine physicals. Some plans provide extras coverage for Dental, Hearing, Eye Care and more. Advantage plans are usually much less expensive than Medicare Supplements.
Medicare also allows the insurance companies to offer the Advantage plans designed to help with SPECIAL NEEDS. There are plans designed for people who are Dual Eligible – that is Medicare and Medicaid and provide all the Medicare benefits plus lots of extras. These plans work with the Medicaid programs so that those with Dual Eligibity do not harm their Medicaid benefits. There are also plans that will only cover people with certain illnesses such as Diabetes, Chronic obstructive Pulmonary Disease and Heart Failure and End Stage Renal Disease. Instead of turning these people down like most insurance companies do, the Special Needs plans want these people.
Most Medicare Part C plans are available to anyone with Medicare A & B, live in the service area of the plan and do not have End Stage Renal Disease, and no other health questions will be asked. If you are looking for a Special needs plan for chronic illnesses, you will be asked health questions to see if you have one that qualifies you for the plan.
Medicare Part C is an important addition to Medicare. It will be around for a long time and each year we see more companies participating, more products brought to the table and to more service areas. The Medicare Part C plans are the wave of the future for the Medicare marketplace.
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To receive a quote for available Medicare Advantage plans, click here, or call us at 888-293-7923 to speak with a Senior Products specialist.
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