Medicare Advantage – Medicare Part C

Medicare Advantage plans are also known as Medicare Part C.  Sometimes, the doctors’ office staff refers to them as Medicare replacement plans.  They really are NOT replacement plans, but an option available to all Medicare Insurance beneficiaries.

These are the plans that are widely advertised on television. There really are no good plans and bad plans, only Medicare plans that suit your needs, that you understand and that you can afford.  Usually, but not always, they come with a built- in prescription drug plan.  The abbreviation is MAPD – Medicare Advantage prescription drug plans.   They are plans that CMS (Centers for Medicare and Medicaid) has a contract with to provide their mutual clients Medicare health coverage.  They are an alternative to having Original Medicare and a Medicare Supplement.  Generally, by contract, these plans must be at least as good as Original Medicare (80/20) and can be better in the fact that they offer a variety of things that Original Medicare does not offer.  Examples of the Extras can be a bundled prescription plan, fitness membership, maybe dental, transportation and over the counter pharmacy items. Two of the main advantages is that they do have a MOOP (maximum out of pocket limit) and a low premium, sometimes zero $ a month. 

Almost all the Medicare C plans are set up as managed care plans.  CMS pays the insurance company a lot of money to take care of you.  Some claim that you get better care because of care coordination.  It generally means that they work in a network of providers who communicate with each other.  Unless, it is an emergency or urgently need care, all medical care must to given by a participating provider to have it as a covered service.  It is particularly important to make sure your doctor and hospital are “in network”.  It is also important to make sure that the built- in prescription plan covers your specific medications. 

These plans can take many forms such as HMO’s, PPO’s, and private fee for service plans.  Where you geographically live, determines which plans and companies are available for you to use.  Generally, you sign a calendar year contract with the Medicare Advantage company.  These plans have yearly contracts with CMS and the benefits can vary significantly from year to year.

Also, if you become dissatisfied with your plan, after the first year, you may not have an option to buy a Medicare Supplement policy.  Further information can be found at www.Medicare.org.