Medicare Advantage

Understanding Medicare Part C: Your Guide to Medicare Advantage Plan

  If you’re new to Medicare, you might have heard about Medicare Part C or Medicare Advantage Plans. Let’s break it down to make it simple and straightforward.

What is Medicare Part C (Medicare Advantage Plan)?

  Medicare Part C, also known as Medicare Advantage Plan, is a program, offered by private insurance companies, that helps cover the cost of medical services and prescription drug costs, if included. The goal is to make your medical care more affordable, helping you maintain your health and well- being. One way affordability is achieved is through a maximum-out-of-pocket limit (MOOP), which is included in all Part C plans. Original Medicare has no such limit. An important note to keep in mind, this MOOP applies solely to medical services, not prescription drug coverage. Please see “Medicare Part D” for an explanation of its cost structure.

  By law, these plans must include all covered Medicare services, except hospice care, so the Original Medicare benefits will not be degraded after enrollment. Medicare Advantage Plans are also assigned a star rating on a 5-star scale. These quality performance ratings are based on customer service, member satisfaction, and health outcomes for its members.

  Medicare Part C coverage can be used as an alternative to Original Medicare Part A and Part B. Medicare Part C plans fall into 1 of 3 categories: a Health Maintenance Organization Plan (HMO), a Preferred Provider Organization Plan (PPO), or a Private Fee for Service Plan (PFFS). Some of these plans are considered Special Needs Plans (SNP), which are tailored to dual members with both Medicare and Medicaid (D-SNP) or for people with Chronic Health Conditions (C-SNP).

  A Medicare Advantage HMO plan typically has the following characteristics:

• Network Restrictions: It requires beneficiaries to use healthcare providers within a specific network, except in emergencies.
• Primary Care Physician (PCP): Beneficiaries usually need to select a primary care physician from within the HMO network and obtain referrals from them to see specialists.
• Cost Containment: May have lower out-of-pocket costs than Original Medicare for services within the network.
• Prescription drug coverage: Although many plans include drug coverage, this is the ONLY Medicare Advantage Plan where a beneficiary is allowed to enroll in a stand-alone Part D prescription drug plan and a PFFS plan. Please see “Medicare Part D” for an explanation of cost structure.
• Coverage for additional benefits: Many plans include coverage for services beyond what Original Medicare covers, such as dental, vision, and hearing.
• Flexibility of care: Emphasizes your flexibility to see any Medicare contracted doctor or use any Medicare contracted facility who is willing to bill the plan and accepts the plan’s terms and conditions.
• Predictable Costs: Typically uses copayments rather than coinsurance, providing more predictable costs for beneficiaries.
• Geographical Limitations: Enrollment in coverage is usually limited to geographical areas, regions, or specific zip codes served by the PFFS network.
• Travel Coverage: PFFS plans may offer more coverage for services received outside of your home area, as any Medicare contracted provider can accept the plan.

Why is Medicare Part C Important?

  As we age, access medical services and affordable prescription medications can become a crucial part of our daily lives. Medicare Part C helps manage these costs, making it easier for you to get the care and drugs you need.

How Does Medicare Part C Work?

  A Medicare Part C or Medicare Advantage Plan works similarly to typical health plans. In most cases, at the time medical care is received, an insurance card (not the Medicare card) must be presented. If a copayment or coinsurance applies, it must be paid by the Medicare beneficiary directly to the service provider.

Enrollment

 You can enroll in a Medicare Part C plan through private insurance companies approved by Medicare. These plans require enrollment during annual enrollment (October 15th - to December 7th) unless certain qualifying events occur, some include being new to Medicare, gain or loss of creditable coverage, change or loss in federal or state financial assistance programs, or a recent move to a new service area. Enrollment periods are specific and time sensitive, so our team will evaluate your situation to ensure you sign up at the appropriate time.

Choosing the Right Plan

Our team will provide, either before or at the time of enrollment, a Summary of Benefits which details the cost structure. This is vital because there are various Part C plans available, each with its own list of rules to follow when receiving care and cost structures. Our team can help you compare plans to find one that best suits your needs, budget, and preferred provider(s).

Costs

• Monthly Premium: Most Part C (Medicare Advantage Plans) have a low to no monthly premium. Keep in mind, you must continue to pay your Part B premium, unless the state pays it for you.
• Deductible: A few plans have an annual medical or prescription deductible, which is the amount you pay out-of-pocket before your plan starts to share the cost of your care.
• Copayments: These are the flat dollar amounts you pay for each service after meeting your deductible. For example, $25.00 copayment to see a specialist or $0.00 to see your PCP.
• Coinsurance: These are the percentage of cost amounts you pay for each prescription after meeting your deductible. For example, 10% of the total cost for a Medicare approved wheelchair.

How Can At Your Service Insurance Brokerage, LLC Help?

  Navigating Medicare Part C can be overwhelming, but you don’t have to do it alone. Our experienced agents are here to help you choose the right plan:

• Answer Your Questions: We’ll explain the details in simple terms and clarify any confusion.
• Compare Plans: We’ll help you review and compare different Part C plans to find the one that fits your needs, budget, and covers the prescriptions you take.
• Provide Enrollment Assistance: We’ll guide you through the enrollment process to ensure you get the coverage you need without hassle.

Contact Us Today!

Your health and peace of mind are our top priorities. Contact At Your Service Insurance Brokerage, LLC today to learn more about Medicare Part C and how we can help you secure the Medicare Advantage Plan you deserve.

Remember, we’re here to support you every step of the way, making Medicare Part C easier to understand and more accessible for you.