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Medicare Advantage Plans

Medicare Part C, more commonly known as Medicare Advantage plans, are a type of health plan offered through private companies that contract with Medicare to provide you with your Part A (Hospital) and Part B (Medical) benefits. Medicare Advantage plans work much like insurance during our working years with networks for doctors and hospitals, deductibles, and co-pays. In addition to their full Medicare benefits, Medicare Advantage plans may also include vision, dental, drug coverage, and more.


What You Need to Know about Medicare Advantage Plans…

You Are Still Part of Medicare: You must have Part A & B of Medicare to be eligible to enroll in an Advantage plan, and while on the plan you still have all of the rights and protections of Medicare.

Networks for Doctors and Hospitals: Each company has its own network of doctors and hospitals. Be sure to check that your current doctors and hospitals are in network for the plan you are selecting.

Pre-Existing Conditions: You can join a Medicare Advantage plan even if you have a pre-existing condition, with the exception of End- Stage Renal Disease (ESRD).

Follow the Rules: In order to avoid extra costs you must be sure to follow the rules of your plan, such as staying in network, and getting a referral to see a specialist.

Additional Benefits: In addition to standard Medicare benefits, many plans include coverage for Vision, Dental, Drugs, and even gym memberships.

Low Monthly Premiums: Premiums for Medicare Advantage plans are typically fairly low since Medicare contracts with these insurance companies to provide your Part A & B benefits on behalf of Medicare.

Super Hint!

Some Medicare Advantage Plans have premiums as low as $0 per month, however you must continue making your Part B premium payments.

Important Note:

Limitations, copayments and restrictions my apply. Each plans benefits, formulary, pharmacy network, provider network, premiums and copayments may change on January 1 of each year. Members need to be diligent about reviewing the plan materials sent to them each year in September to see what is changing.

Medicare Advantage Explained...

With a Medicare Advantage plan you will be responsible for co- payments and other out-of-pocket expenses when you use your coverage. Each company sets its own cost-sharing for each covered service. As an example, you might pay a copay for a primary care doctor visit, a higher copay for a specialist, and a percentage of the cost of services such as x-rays or lab tests. When you use Medicare Advantage coverage in the hospital you may pay either a fixed amount per day or a flat amount for the whole stay.

All Medicare Advantage plans must include an annual maximum cap on your out-of-pocket medical costs. The cap can be no higher than $6,700 per year but some plans have lower out-of-pocket maximums. Think of this as a safety net. If your medical bills add up to $6,700 in one year, your plan will step in and pay the rest of the cost for the remainder of the calendar year. Part D Drug costs are not included in this number.

Medicare Advantage plans may also include extra benefits not provided by Original Medicare such as vision benefits, limited dental coverage, or gym memberships. It is important to remember the insurance company has the right to change these benefits each year. Medicare Advantage plans also typically include Part D drug coverage.