Your Medicare Advisor

Understanding Medicare Part C

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Dear AMAC,

I keep hearing ads on television about Medicare Part C plans that offer additional benefits. I want to know exactly what these plans are and if they are worth it. I don’t want to lose the coverage I have now, but it would be nice to have some dental and vison benefits.

-Elaine (Stone Mountain, GA)

 

Dear Elaine,

Your question is one we hear every day, so you are not alone. We are bombarded with advertisements through printed mail, TV, and radio for Medicare Part C, also known as Medicare Advantage. But many are still unaware of what that is. Let’s break down what this coverage entails.

Medicare Advantage Plans are a type of Medicare health plan that replaces your Original Medicare Part A and B. Although your Original Medicare will not actually terminate, your Medicare Advantage Plan will be your primary and only insurance that will be used.

These plans cover hospital care, medical services, and prescription drugs under one plan; however, you can choose an Advantage Plan without drug coverage if you wish. Medicare Advantage Plans use a network of providers much like an HMO or PPO, so you will want to make sure any providers you currently see accept the plan’s terms. Unlike Medicare Supplement Plans, Medicare Advantage Plans are not portable. So, if you move to a new area you will have to change your plan.

Medicare Advantage plans usually have lower monthly premiums, or even no premium in most areas. But keep in mind that you will have copays, coinsurance and possibly deductibles as you use the plan for different services like lab work and hospital care. This is why they are often referred to as “pay-as-you-go plans.”

Medicare Advantage Plans can offer benefits over and above what Medicare covers, like dental, vision, acupuncture, fitness memberships, transportation, and over-the-counter benefits. A person may consider enrolling into a Medicare Advantage Plan if they are comfortable with paying copays in exchange for a lower premium and don’t mind using network doctors.

It is important to know that you may not have another Medicare health plan, Medicare Supplement, or employer coverage in addition to your Medicare Advantage Plan. It is either one or the other. So, if you do not want to lose your current coverage, you may want to investigate the Advantage Plans further to see if it is something that would benefit you instead of the coverage you have now.

Thank you, Elaine, for reaching out to your Medicare Advisors here at AMAC!

If you or someone you know could benefit from our complimentary services, give us a

call at 855-611-4856 and one of our licensed, knowledgeable advisors will be happy to assist you.


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Ken
2 months ago

One thing I haven’t seen mentioned in the comments is that, to my understanding, if you have Original Medicare and switch to a Medicare Advantage Plan, if you want to switch back to Original Medicare you will have to go thru ‘underwriting’. If you have any ‘pre-existing conditions’ you can be sure that original Medicare will probably deny you the opportunity to switch back and you probably wouldn’t be able to get approved for a Medigap plan also.

Editor
Sabrinah Cave
2 months ago
Reply to  Ken

Hello Ken,

Although you will not be medically underwritten to go back to Original Medicare, you will be underwritten if you choose to elect a Medicare Supplement plan- unless you have a Guaranteed Issue Right that will allow you to bypass the underwriting.

However, if you elected a Medicare Advantage Plan for the first time when you turned 65 and have had the plan less than a year, you will have a Trial Right to go back to Original Medicare and select a Medicare Supplement without going through medical underwriting.

Additionally, if you had a Medicare Supplement Plan and switched to an Advantage Plan for the first time, you could go back to your Medicare Supplement Plan without going through medical underwriting within the first year.

If these situations do not apply to you, and you have to go through medical underwriting, then it is surely something to consider before making plan changes.

Thank you for your comment!

Jim
2 months ago

I’ve had an Advantage plan for 3-4 years after 10-11 years of buying high cost supplemental and drug plans. I have 0 premiums and my drug plan, some dental, vision, and some other perks are included. Each quarter I can order $75 in over the counter products like toothpaste, pain relievers, bandages, etc. free of charge. My drugs are mostly tier 1&2 so they are completely cost free if I order through my plan’s mail order pharmacy. Treatments and visits with my primary care doc are without copay. Specialists like cardiologists, back doctors, and dermatologists are $20 copay. Surgical procedures if done in the doctor’s clinic are $20 copay, but $150 in a surgery center. I’ve had no problems at all with selection for physicians or the specialists I’ve wanted. I live in the Dallas/Ft Worth metroplex and coverage by my plan in this area is plentiful and high quality. I believe that my Advantage plan has saved me a lot of money the last few years. Also, I could not ask for better medical care. I’m sure that there are probably other areas where there could be more limited selections for doctors or hospitals, but I’m glad I switched to Advantage from regular Medicare with separate supplements and drug plans.

Editor
Sabrinah Cave
2 months ago
Reply to  Jim

Thank you for your input Jim! I am glad to hear your plan is working well for you.

Carolyn Rottman
2 months ago

Thank you. This helped me understand Advantage plans.

Wayne Peterkin
2 months ago

Left out importent things like you are essentially turning all of your Healthcare decisions over to the insurance company and it’s network providers, and that company has a profit incentive to minimize your care. The choice of providers in various areas may be very limited and in rural areas may require long distances to get care.

Dan W.
2 months ago
Reply to  Wayne Peterkin

Good point.

Why limit yourself to a specific list of network providers just to save a few dollars in premium each year ?

Editor
Sabrinah Cave
2 months ago
Reply to  Wayne Peterkin

Hello Wayne,

You make some really valid points. Now, the insurance company does not control your healthcare decisions per se. They may require prior authorization for certain services to prove that it is medically necessary, but this is a common practice.

A lot of carriers actually give incentives to their enrollees for prioritizing their health through activities like excercise, staying on top of their preventive health, and nutrition classes.

Medicare Part C is a network plan, so in some instances you can be limited to network doctors, especially in rural areas. This is why we never use the term “best” when it comes to insurance, because it really depends on what is offered in your area and if it can work for you.

Thank you for your comment, it truly helps further our dialogue!

Rob
2 months ago
Reply to  Sabrinah Cave

Be aware that profit incentives rule for these companies Advantage plans. They got their money from medicare and their goal is to hold onto nearly every dime (remember HMO’s – these are the same). Sure they promote some wellness programs because they receive incentives from medicare. BUT, good luck with MRI’s, CT scans nuclear stress tests, etc. They use third party “hired guns” whose sole role is to deny under the guise of “medically appropriate”. Sneaky ways besides denials, sometimes require patient laying out many 100’s to thousands of dollars in therapy copays or other. Many if not most give up in the face of this. Supplements (G plans)are pricier but not denied the care.

Dan W.
2 months ago
Reply to  Rob

And if you want to stick with original Medicare and also buy a Medicare Supp (Medigap) plan, you will pay less Medicare Supp monthly premium, if you buy the Medicare Supp Plan G (High Deductible) which has a $2,490 deductible.

The Plan G (High Deductble) monthly premium can be $100 per month cheaper than the standard Plan G and the $2,490 deductible is substantially lower than the Maximum Out-of-Pocket limit of Medicare Advantage plans.

As previously noted, you can only buy Medicare Supp (Medigap) plans if you elect original Medicare. Medicare Supp plans are not allowed for people who elect Medicare Advantage plans.

jim
2 months ago

You must remember it will cost you more if you get an illness like cancer, bills are split roughly 80-20
with you paying 20 percent+ copays. We had an Advantage plan and when my wife got cancer, we ended up 20% of $8000.00 chemo bills ! That adds up quickly. Because you can’t get a supplement
plan under that plan. It could cost you a lot more when and if you get sick.

Jeanne
2 months ago
Reply to  jim

My brother has Medicare advantage and also has a supplemental insurance – united healthcare.

Dan W.
2 months ago
Reply to  Jeanne

Can you clarify with your brother that he has both a Medicare Advantage plan and a Medigap (Medicare Supp) plan that picks up his share of the coinsurance ?

According to the above posted article, a Medigap policy on top of a Medicare Advantage plan is not allowed.

Editor
Sabrinah Cave
2 months ago
Reply to  Dan W.

Correct, you cannot have both a Medicare Advantage Plan and a Medicare Supplement plan at the same time.

Dan W.
2 months ago
Reply to  jim

That’s the financial concern with Medicare Advantage plans.

You could pay up to $7,500 out-of-pocket each year if you have a large medical claim and unlike original Medicare plans, there is no option to buy a separate Medigap policy to cover potential out-of-pocket medical expenses.

Editor
Sabrinah Cave
2 months ago
Reply to  Dan W.

Great point Dan!

Editor
Sabrinah Cave
2 months ago
Reply to  jim

Hello Jim,

First of all, I am sorry to hear that and I hope your wife is well. This is an example where you could wind up paying a significant amount out of pocket with a Medicare Advantage Plan. All of these plans do have something called a “Maximum Out of Pocket” limit, and this refers to how much you can spend out of pocket for the year on covered health services.

With HMO plans it can be around $5,000 and with PPO plans it may be as high as $11,300. Usually, you pay a portion of covered costs, like 20% in your example for Chemotherapy, until you reach the plan’s maximum.

Therefore, it is very important to consider the Maximum Out of Pocket limit when you are shopping for Advantage plans and make sure it is something you are comfortable with in the event something unexpected happens.

That you for your comment.

Susan
2 months ago
Reply to  jim

My mother also has cancer. Stage 4 breast. She has an advantage plan and has paid out less than $400 over several months. She’s had radiation treatments and takes oral treatments daily which are billed out to her insurance at over $12,000 a month. She has very expensive blood work done bi-weekly and CAT scans quarterly. Doctors co-pay is $5. She also had surgery for a broken femur and the entire hospital bill was under $200. She was in for over a week. $170 monthly out of her social security check is all she pays.

Editor
Sabrinah Cave
2 months ago
Reply to  Susan

Hello Susan,

Give your mother my best; I am glad she has a plan that helps her pay for all those very expensive services. This is a great example on how a Medicare Advantage plan can work for you.

Thank you for your comment.

Gerry Shutrump
2 months ago

Thank You. This is very helpful.

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