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Introduction To Medicare Advantage (AKA) Medicare Part C

Medicare Part C, also known as Medicare Advantage is a very popular choice for many seniors. Let’s explore what medicare advantage plans might be able to offer you.

The U.S. federal government provides for Medicare program recipients to be covered by the proper benefits to suit their healthcare requirements. The Medicare Advantage Plan (MA Plans) is one of the Medicare health plan offerings to the insured through private companies contracting with the Medicare program.

Since enactment of the Affordable Care Act (ACA) in 2010, the insured have had more options in healthcare coverage. In 2014, all Americans were mandated to sign up for a healthcare insurance plan or sustain penalties. Part C improves the range of services mandated that the insured have access to through Medicare.

For the MA-insured an, services that would otherwise not be covered through Part A and C are assumed by MA Plan benefits. Part C includes coverage for prescription drug services.

Medicare Advantage Plans supplements Part A and B of Medicare’s basic coverage. Plan C covers services through:

This also includes HMO Point-of-Service (HMOPOS) Plans. Designed for out-of-network service provision, these are rated at a higher cost, under the original plan.

Joining the Medicare Advantage Plan movement

Medicare plan holders are eligible for HMO, PPO, PFFS or MSA programs if the live in the same service area as the plan of choice. One requirement is that applicants must be insured under Medicare Part A and Part B. Another is that applicants must have evidence that they do not have an end-stage renal disease (ESRD) diagnosis.

The insured can switch to the Medicare Advantage Plan by joining during one of the scheduled enrollment periods. Disenrollment from a former plan goes into effect at time of joining. The Medicare Part C insured also have access to Part D prescription drug coverage. The insured are entitled to elect Medicare Supplement Insurance coverage, under a Medigap policy. Application to this supplemental coverage is held several times a year.

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If already Medicare-insured, beneficiaries with ESRD can seek exemption from restriction from the Medicare Advantage plan. They are also exempt if Part C benefits are offered through their employer Medicare Advantage coverage. Those diagnosed with ESRD that have had a successful kidney transplant qualify for Part C benefits.

The Medicare Special Needs Plan (SNP) makes allowance for people with ESRD. Insured members have the one-time right to participate in another Part C plan or return to services offered through Part A and B. For this to occur, an existing Medicare Advantage Plan program provider must leaves Medicare. Or, the Medicare Advantage plan must no longer offer services in an existing ESRD patient’s area.

The Benefits to a Medicare Advantage Plan

Medicare Advantage Plan Part C is a partnership offered through Medicare-approved private providers. The insured with MA Plans are still covered by Medicare Part A (hospital insurance) and Part B (medical insurance). Medicare subsidizes each recipient’s healthcare coverage every month. Medicare Advantage Plans companies are bound by contract with Medicare to provide services to the insured, in exchange for discounted services.

Medicare Advantage indices reflect an annual estimated scale of out-of-pocket costs for specific services. Not all Medicare Part C companies cover the same amount for each service or treatment. Specialist treatments in hospital or clinical facilities and nonemergency or nonurgent care costs are designated as having average cost; at times, these are only partly covered by Part C private insurers. The remainder of the treatment costs, in respect to special services and fee-for-service fees, is the responsibility of the insured.

Drug coverage by Part C is only met if Prescription Drug Coverage (Part D) supplements the insured’s plan. The Medicare Prescription Drug Plan is the alternative to paying entirely out of pocket for prescription drugs.

The insured are prohibited from obtaining dual prescription drug insurance policies. The federal rules to Medicare Advantage Plans stipulate that the insured cannot be recipients of both the Medicare Prescription Drug Plan and an external drug coverage plan, while enrolled in Medicare Advantage.

How to join a Medicare Advantage Plan

The Medicare Plan Finder on the Medicare website offers information and an enrollment schedule for Medicare Advantage Plan applicants. If already enrolled in Medicare Part A and Part B, members will be familiar with the Medicare enrollment process.

Enrollment in Medicare Advantage can only be done during the scheduled annual periods. If an employer has a Medicare Advantage policy, they can usually enroll through their employer, with follow-up on any requests solicited by Medicare.

When an insured member joins a Medicare Advantage Plan, they must provide Medicare with their existing insurance number. They must also provide the date that the existing Medicare Part A and Part B coverage went into effect. The insured number and date of plan start can be found on all Medicare cards.

Medicare expressly prohibits plans from calling the insured by phone to initiate enrollment. All Medicare applications must be submitted by the insured. Or, a preparer can submit the applications on behalf of the insured, with their legal consent. Medicare recipients requiring guardianship or third-party assistance in filling out a Medicare Advantage Part C application must follow the same process as all Medicare-insured.

It’s important that you never provide bank account or credit card numbers or security codes to Medicare agents over the phone; this prevents insurance fraud. If requested, report Medicare fraud abuse to the Social Security Administration or CMS.


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