Medicare Part C is actually a Health Insurance Plan to go with Original Medicare.
Medicare Advantage plans came into existence in 1997. Like Medicare Medigap plans, they offer coverage to help lower the cost sharing associated with Original Medicare. Unlike Medigap plans, they offer plans with little or no premium but they also come with higher cost sharing when utilizing Medicare covered services. Which means there are copays for pretty much everything you do. Medicare Advantage Plans mirror the Health Insurance Plans we’ve used our whole lives. Unlike Medicare Supplement/Medigap plans, some Medicare Advantage plans come with a Part D Prescription Drug plan coverage included.
The 4 most popular types of Medicare Advantage Plan are-
HMO- Health Management Organization– This type of plan was the first type of Medicare Advantage Plan to be used. The term “Health Management” refers to coordinated care by a Primary Care Physician (PCP). This means that your Primary Care Doctor is involved with all aspects of care including visits to a Specialist which prompted the requirement of a referral. Also, HMO’s have a set Doctor/Hospital network that Medicare Beneficiaries have to stay in or pay the Full Cost(Medicare Rates) of the visit. Recently, HMO plans have eliminated the referral requirement but the need to stay in the network remains. Most plans still require choosing a Primary Care Physician prior to enrollment.
PPO- Preferred Provider Organization– PPOs were developed as an alternative to HMO’s to provide more flexibility. Medicare Beneficiaries can go in and out of the plan network but incur a higher cost when going out. A “Preferred Provider ” is an “In-Network” provider which will come with a lower cost than an out of network provider. This applies to Hospitals, labs and any other Medicare covered services. When using an out of network provider a Beneficiary may have to pay the full cost (Medicare Rate) to the provider and get reimbursed by the Insurance Carrier up to the out of network copay
.DSNP-Dual Special Needs Plans- Plans that are available to individuals that are enrolled in both Medicare and Medicaid
CSNP- Chronic Special Needs Plan– Plans that are available to individuals with specific Chronic conditions.
Medicare Advantage Plans also offer services over and above Original Medicare. Many plans offer services such as-
Over The Counter Cards