A Medicare Advantage Plan (Part C) is a health plan offered by private insurance companies in which a Medicare beneficiary can opt to take in lieu of Original Medicare coverage.
Medicare Advantage Plans are required to offer all of the same benefits that Original Medicare provides, including Part A (Hospital) and Part B (Medical), and in most cases, these plans tend to offer additional benefits such as dental, vision, hearing and even Part D (Prescription Drug Coverage).
How it works
When someone joins a Medicare Advantage Plan, the Federal Government pays a fixed amount to the private insurance company that will now be responsible for providing health insurance to that person. The private insurance companies that offer Medicare Advantage plans must get approval by the Federal Government to offer the plan, and it is a very strict process to ensure that the members are in good hands.
Some individuals join one of these plans because it reduces their overall out-of-pocket expenses. For example, these plans must have a maximum out-of-pocket amount which is a safety net for the insured, whereas, on Original Medicare, there is no maximum out of pocket.
When opting for a Medicare Advantage Plan, the insured typically will have a choice between a PPO (Preferred Provider Organization) and an HMO (Health Maintenance Organization).
A Medicare Advantage PPO is a plan which utilizes a network of doctors, but as an added benefit, the plan allows the insured member to seek care outside of the network at their own discretion.
A Medicare Advantage HMO is a plan which utilizes a network of doctors and does not allow the insured to go out of the network.
Also, all Medicare Advantage Plans (PPOs and HMOs) typically have an outline of benefits that usually include set co-pays for services, so the insured is able to know exactly how much a certain service will cost beforehand.
Who can join?
In order to join one of these plans, the insured must be enrolled into Part A (Hospital) and Part B (Medical) coverage, they must live in that plan’s service area (zip code), and they must not have End-Stage Renal Disease.
If an individual meets these qualifications, they can join a plan during Initial Enrollment Period (when they first join Medicare), Annual Open Enrollment Period (Oct 15th – Dec 7th) or during a Special Enrollment Period (Jan 1st – Dec 31st) if they qualify for one of the many special elections.
I can help
If you would like more information or help in making a decision, that’s what I’m here for. I work with every Medicare plan in Clark County and throughout Nevada. And of course, there is no cost to my services.