Medicare Part C – Medicare Advantage Benefits

What Are Medicare Advantage Plans?

A Medicare Advantage Plan is a health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. So, if you elect a Medicare Advantage Plan, you still have Medicare, but you will receive your Part A and Part B benefits through a private insurer. Most Medicare Advantage Plans offer prescription drug coverage. Because Medicare pays the insurance companies for your care, they must follow the rules set by Medicare.

However, when it comes to out-of-pocket costs and procedures for how you get services, not all plans are created equal. If you have been covered by an HMO or PPO in the past you may have experienced the restrictions.

  • In general, HMO’s make it difficult to get out-of-network care; while in a PPO you can go out of network if you are willing to assume additional cost.
  • Find out what happens if you are outside the plan’s service area. Do they only pay for emergency care?
  • You cannot have a Supplemental Insurance policy (Medigap) with Medicare Advantage so look at all your potential expenses as your out-of-pocket costs can vary widely from plan to plan.
  • Do you have preferred doctors and hospitals? If so, you may want to choose a plan that has them within the network.
  • Check with the plan providers to find out if your prescription drugs are on the plan’s preferred list of drugs.

Medicare Guidance on Various Type Plans

Click on the following links for additional Medicare guidance on the various plan types:

Who Can Enroll in Medicare Advantage?

You can generally join a Medicare HMO, PPO, Private Fee-for-Service (PFFS), or Medicare Medical Savings Account (MSA) Plan if you:

  • Live in the plan’s service area
  • Have Medicare Part A and Part B
  • Do not have End-Stage Renal Disease (ESRD).

Call 877-734-3441 TTY:711 to find out what plans are available in your area.

When to Enroll in Medicare Advantage

Medicare’s open enrollment runs from Oct. 15 to Dec. 7, 2012. During this period, you can switch from one Medicare Advantage plan to another or move to Medicare Advantage from Original Medicare or move from Original Medicare to Medicare Advantage.

How to Enroll or Switch Policies in Medicare Advantage

Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare health plans in your area. Call 877-734-3441 TTY:711 to find out which plans are available in your area and meet your unique needs.

How to Switch to Original Medicare

Contact your current plan, or call 1-800-MEDICARE. If you do not have other drug coverage, carefully consider Medicare prescription drug coverage (Part D). You may also want to consider a Medicare Supplement Insurance (Medigap) policy. Remember, you may only be able to switch at certain times of the year. Call 877-734-3441 TTY:711 to find out which plans are available in your area and meet your unique needs.

In the Event Your Plan Stops Participating in Medicare

Plans have been occasionally known to leave the program at the end of the year. You can either join another Medicare Advantage plan or return to Original Medicare and have the option to buy a Medigap policy. Similarly, if you want drug coverage with Original Medicare you will need to join a Part D plan or another Medicare Advantage Prescription Drug program (MAPD).

Medicare Part C Benefits