Medicare Advantage Part C

When researching your Medicare coverage options, you will learn that you can choose a Medicare Advantage Part C plan as a private alternative to Original Medicare Part A and B.  If you join a Medicare Advantage plan, you replace your Original Medicare Part A and B. You will follow the contract benefits from the Medicare Advantage Plan you choose. These plans have network limitations, and some will require you to get referrals to visit specialists. Most plans include prescription drug coverage and extra benefits like routine dental care, vision, hearing, and fitness memberships.

You must stay enrolled in both Parts A and B while enrolled in your Medicare Advantage plan. It usually works like this:

1. You’ll show your Advantage plan ID card at the time of medical treatment.
2. Your providers will invoice the plan instead of Original Medicare.
3. Medicare Advantage plans have a plan with zero-premium or low premiums.
4. You pay copays for medical services as you go, up to the plan’s out-of-pocket maximum, which can be up to $10,000 per calendar year. This limit differs by plan and doesn’t include Part D spending.
5. With Medicare Advantage plans you will be responsible for deductibles, copays, and coinsurance up to the plan’s out-of-pocket maximum.
6. Be aware that doctors and hospitals can drop from the network at anytime
7. Be aware that plan benefits and drug formularies can change.
8. HMO plans are the most popular Medicare Advantage plan. The copays and deductibles are lower, but they require you to have a Primary doctor to coordinate your benefits and require referrals to see specialists.

When can I change my Medicare Advantage Plan?

In most cases, you must keep your Medicare Advantage Plan for the full year from January- to December. During the Annual Enrollment Period from October 15 to December 7, you can make changes to your Medicare Advantage Plan and coverage will begin on January 1. There is another opportunity to make changes during the Medicare Advantage Open Enrollment Period which from is January 1 to March 31^st. However, you may be entitled to a Special Enrollment Period (SEP) where you can change your plan in the middle of the year. Call Coastal Medicare Advisors to see if changes to your Medicare Advantage Plan would benefit you!

Most popular Medicare Advantage Plans

Medicare Advantage PPO

Medicare Advantage PPO plans are offered by private insurance companies. Like other Preferred Provider Organization plans, these have a network of doctors, other health care providers, and hospitals.

You’re not required to use someone within the network. However, if you use this network, you pay less. If you go outside of the network for health care, you pay more.

Medicare Advantage HMO

Medicare Advantage HMO plans are offered by private insurance companies. Like other Health Maintenance Organization plans, you have a network of healthcare providers, doctors, and hospitals. You will have to choose a primary care physician and this doctor will have to be the one who refers you to see a specialist.

Only in urgent emergencies are you able to receive coverage outside of the plan’s network.

Dual Eligible Special Needs Plan (DSNP)

Some beneficiaries also qualify for Medicaid, which is a health insurance program for those with low incomes. When you qualify for Medicare and Medicaid, you can maintain your Original Medicare and have Medicaid operate as your secondary coverage, or you can sign up for a Dual Eligible Special Needs Plan.

The costs to join will be mostly covered for you. Expect to spend little (or nothing) on copays, deductibles, and coinsurance for Part A and Part B services that the plan provides. Since Medicaid pays any premium for you, many DSNPs have a $0 premium.

DSNPs offer extra benefits like the following:

• Gym memberships
• Routine dental, vision, and hearing benefits
• Quarterly benefits for over-the-counter products
• Transportation to and from doctor’s appointments or trips to the pharmacy

Call Coastal Medicare Advisors to verify if you qualify for a Dual Eligible Special Needs Plan!