Medicare Part C is a health insurance plan with Original Medicare.
Medicare Advantage plans came into existence in 1997. Like Medicare Part C 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 include Part D Prescription Drug plan coverage.
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 a referral requirement. Also, HMOs 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 before enrollment.
PPO- Preferred Provider Organization– PPOs were developed as an alternative to HMOs 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 comes at 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 provider the full cost (Medicare Rate) 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 who are enrolled in both Medicare and Medicaid
CSNP- Chronic Special Needs Plan– Plans that are available to individuals with specific Chronic conditions.
Additional Benefits-
Medicare Advantage Plans also offer services over and above Original Medicare. Many plans offer services such as
Dental Coverage
Vision Coverage
Hearing Aids
Gym Memberships
TeleHealth Services
The Counter Cards
Frequently Asked Questions
Do Medicare Advantage Plans have Doctor and Hospital networks?
Yes, some are larger than others. Care should be taken when choosing one.
Do Medicare advantage plans include a Drug Plan?
Yes, most have a Part D Rx Plan embedded in them.
Do all Medicare Advantage Plans come with Dental and Vision coverage?
No, some have more comprehensive coverage than others.
Mike Miligi- Owner- Michael M Insurance Services
For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(Part D), and Dental and Vision programs.
Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options.
