Medicare Part C

One of the options a Medicare beneficiary has as a resource to tackle Original Medicare’s Co-Insurance, Co-Pays, and Deductibles is through the use of a Medicare Advantage plan, also known as Part C. Medicare Advantage Plans are CMS-approved insurance plans offered through private health insurance companies. They combine Original Medicare, Part A, Part B, and generally Part D into one plan. Enrolling in a Medicare Advantage plan requires a person to enroll in Medicare Part A & Part B and reside in the plan’s service area. Medicare Advantage plans, at a minimum, include all benefits, services, and coverages outlined in Original Medicare. They generally have additional benefits and services Medicare does not cover, such as:

• Preventative Care & Wellness Programs.
• Routine Hearing Exams & Hearing Aids.
• Routine Vision Exams & Corrective Lenses.
• Comprehensive Dental Coverage.
• Worldwide Emergency Assistance Outside The U.S.

If a person enrolls in a Medicare Advantage plan they must continue to pay their Original Medicare Part B premium. With that said, Medicare Advantage plan premiums cost around $0 to $60 a month, depending on the plan chosen. A very affordable option to reduce the exposure of Medicare’s 20% co-insurance. By selecting a Medicare Advantage plan, the insurance company becomes your primary insurance, and by doing so, it has very distinct advantages and disadvantages, such as: Advantages:

• It Has A Low or No Monthly Premium.
• Part D Is Generally Included In The Plan.
• It Provides Predictable Out-of-Pocket Costs.
• Usually Includes Extra Benefits Not Provided By Original Medicare.

Disadvantages:

• As A Rule, Working Within A Network Is Mandatory.
• Normally, Working With A Primary Care Physician Is Necessary.
• In General, It Requires A Referral To See A Specialist.

Two Types of Medicare Advantage Plans – HMO or PPO:

HMO – Health Maintenance Organization:

• Cover Eligible Services For Providers And Facilities Inside The Network Only, Except In An Emergency.
• As A Rule, Have A Very Narrow Network Confined To A Specified Geographical Area.
• In-Network Out-of-Pocket Expenses Are Limited.
• Out-of-Network Expenses Are Mostly Out-of-Pocket.
• Normally, Require A Primary Care Physician.
• Typically, Require A Referral To See A Specialist.
• Generally, Require Pre-Authorization For Procedures.

PPO – Preferred Provider Organization:

• Cover Eligible Services For Providers And Facilities Inside The Network.
• Cover Eligible Services For Providers And Facilities Outside The Network.
• As A Rule, Have A Broad Network With Nation Wide Coverage.
• In-Network Out-of-Pocket Expenses Are Limited.
• Out-of-Network Out-of-Pocket Expenses Are Limited.
• Normally, Do Not Require A Primary Care Physician.
• Typically, Do Not Require A Referral To See A Specialist.
• Generally, Do Not Require Pre-Authorization For Procedures.

Choosing a Medicare Advantage plan does not mean a person is bound to the Medicare Advantage plan selected during their Initial Enrollment Period indefinitely. There are enrollment timelines when a person can make changes to their coverage if needed or wanted.

Medicare Advantage Plan Enrollment Timelines:

Annual Election Period Oct 15th – Dec 7th: Compare And Find The Best Plan For The Next Calendar Year. Coverage Changes That Can Be Made:

• Change To A Different Medicare Advantage Plan.
• Switch From A Medicare Advantage Plan To Original Medicare.
• Switch From Original Medicare To A Medicare Advantage Plan.
• Change, Join or Drop Part D Prescription Drug Coverage.
• Coverage Will Become Effective On Jan 1^st.

Open Enrollment Period Jan 1st – Mar 31st: Set Aside For People Enrolled In A Medicare Advantage Plan. Coverage Changes That Can Be Made:

• Change To A Different Medicare Advantage Plan.
• Switch From A Medicare Advantage Plan To Original Medicare.
• Join A Separate Part D Prescription Drug Plan.
• Changes Can Only Be Made Once During This Time.
• Coverage Will Become Effective The 1st Of The Following Month.

Lock-In Period Apr 1st – Dec 31st: No Plan Changes Allowed Unless A Qualifying Event Creates A Special Election Period. Such As:

• Moving Outside A Plan’s Service Area.
• Losing Employer Group Coverage.
• Qualify For The Medicare Savings Plan (Medicaid For Over 65).
• Qualify For Extra Help With Prescription Drug Costs (LIS).
• Loss Of Special Needs – Extra Help or Medicare Savings Plan.