Medicare Advantage (Part C) Plans

Medicare Advantage (Part C) plans are all-in-one plans that combine the coverage of Original Medicare (Parts A & B) with extra benefits you can't get from Original Medicare alone. Most also include prescription drug coverage (Part D) and may also offer additional benefits such as dental, vision, hearing, wellness and fitness programs. All these features are often provided with no additional premium up-charge.

Medicare Advantage plans operate within defined geographic areas called service areas. Consequently, you must live in a plan's service area to become a member, and a plans' coverage and costs can vary by individual plan design and location.

What exactly do Medicare Advantage (Part C) plans cover?

All Medicare Advantage Plans Cover:

• All the benefits of Part A (hospice coverage may be provided, but if not, will still be covered by Origninal Medicare Part A.
• All the benefits of Part B

Most Medicare Advantage Plans Cover:

• Prescription drugs

Additional Benefits Medicare Advantage Plans May Offer:

• Dental exams, cleanings and X-rays
• Eye exams, eyeglasses and corrective lenses
• Hearing test and hearing aids
• Wellness programs and fitness memberships
• Other extra benefits such as transportation to medical appointments and over the counter items

Important things to know about Medicare Advantage plans

• Some plans will have provider networks, some will not
• Out-of-pocket cost limitations vary by plan
• Monthly plan premium vary by plan allowing you to customize to your budget

What types of Medicare Advantage (Part C) plans are there?

Most Medicare Advantage plans are coordinated care plans. Coordinated care plans have a network of providers. If you use the plan's network doctors and providers, you will generally pay less out-of-pocket for care.

• Health Maintenance Organization (HMO) plans                                                                    HMO plans use a defined network of providers with a primary care physician to help coordinate care. HMO plans usually only pay for doctors and providers in the plan network.
• Point of Service (POS) plans                                                                                                POS plans have the rich benefits of an HMO, but with more flexible doctor/provider choice. Costs are generally lower for using in-network doctors/providers.
• Preferred Provider Organization (PPO) plans                                                                        PPO plans cover doctors and providers both in and out-of-network. These plans generally pay a smaller portion of the cost when using out-of-network providers.
• Private Fee-For-Service (PFFS) plans                                                                                   PFFS plans may or may not have a network of providers, but generally will cover any provider who accepts Medicare and accepts the plans payment terms and conditions. Also, each provider has the option and right to accept or deny each patient on a case-by-case basis.
• Medical Savings Account (MSA) plans                                                                                   MSA plans combine a high-deductible health plan with a special savings account. Medicare deposits funds that are withdrawn tax free to pay for qualified health services. You can see any doctor/provider you choose. MSA plans don't cover prescription drugs, but you can enroll in a stand-alone Part D plan separately.

*Not all plans are available in all areas.

What does Medicare Advantage (Part C) cost?

Each Medicare Advantage (Part C) plan sets its own specific costs, but the types of costs they include are similar. Most plans use a combination of deductibles, co-pays and co-insurance to share the cost of the services you use. Appropriately named, this is called cost share. Cost-sharing usually applies to all benefits the plan covers. Below you'll find a brief discription of each type of cost-share.

• Premium                                                                                                                                 Premiums are typically paid monthly and they do vary by plan and area. In some areas it is not uncommon to see a $0 montlhly plan premium. However, you always still pay the Part B premium to Medicare.
• Deductible                                                                                                                                     A deductible refers to a certain amount of money paid by you, the member, each year before your plan starts to pay anything for covered plan services. Some plans charge an annual deductible and some do not. If you have chosen a Medicare Advantage (Part C) plan then Original Medicare (Part A & B) deductibles do not apply.
• Co-payment                                                                                                                               By definition a co-payment or co-pay is a fixed amount of money determined by the plan that you are required to pay for a covered service. For example, a typical primary care doctor office visit co-pay might be $20.
• Co-insurance                                                                                                                          The concept of co-insurance is different from co-pay in that instead of a fixed dollar amount, rather you pay a percentage of the cost of the covered service. For example, your cost-share, if you were responsible for co-insurance, might be 20% or 40%.