Medicare Part C plans are part of the Medicare Advantage Plans, which are offered by private companies approved by Medicare. Medicare Advantage Plans cover all Part A and B expenses, which include Hospital Insurance and Medical Insurance. In addition to this, most plans cover Part D, which is coverage for prescription drugs. A specific amount is paid by Medicare each month to companies offering Advantage Plans. In order to keep receiving money, these companies are required to abide by the rules set by Medicare. Each Medicare Advantage Plan has the right to charge varying out-of-pocket costs. In addition to this, they're also allowed to have different rules regarding how services are obtained. For example, they are able to determine whether or not a referral is needed to see a specialist. Rules are subject to change each year.

Summary of Medicare Advantage Plans. The most common types of Medicare Advantage Plans include the following:

  • HMO - Health Maintenance Organization
  • PPO - Preferred Provider Organization
  • PFFS - Private Fee for Service
  • SNP - Special Needs Plan

In addition to these plans, there are Medicare Advantage Plans that are less common. However, many of them are still available. They include:

  • HMO Point of Service - This plan, which is also called HMOPOS, allows members to obtain certain services out of their network for a higher price.
  • Medical Savings Account - An MSA plan is one that combines a bank account and health plan with a high deductible. Medicare deposits amounts less than the deductible into the plan. Those funds may then be used to pay for health services.


Costs of Medicare Advantage Plans. There is a monthly premium for these services, which is usually combined with the regular Part B premium to create one easy payment. Since all Medicare Advantage plans vary in their terms, people usually pay different amounts for their out-of-pocket expenses. These expenses depend on the following:

  • Whether the plan covers part or all of the Part B monthly premium.
  • How much is paid for each service or visit.
  • Whether the plan includes an annual deductible or additional deductibles.
  • The plan's annual out-of-pocket cost limits for medical services.
  • Whether extra benefits that the plan covers are needed.
  • Whether there is a monthly premium for the plan.
  • The type of health services needed and how often they're used.
  • Whether plan rules, especially regarding network providers, are followed.

What Is Covered. Both emergency and urgent care services are always covered under Medicare Advantage Plans. Advantage Plans are not supplemental. They must cover all services that Original Medicare covers. However, hospice services are an exception. Hospice is covered by Original Medicare even if an individual is enrolled in a Medicare Advantage Plan. In addition to prescription drug coverage, many of these plans cover vision, dental, hearing, health programs and wellness programs.

Important Considerations with Advantage Plans. There are several important things to consider about these plans. Recent changes were made, so the provisions may not be the same as they once were. Plan coverage starts the first day of the month following the arrival of the enrollment form at the office headquarters. During that period, avoid the following:

  • Switching from Original Medicare to an Advantage Plan.
  • Switching from one Medicare Prescription Drug Plan to a different one.
  • Joining, dropping or switching a Medicare Medical Savings Account Plan.
  • Switching from one Medicare Advantage Plan to a different one.

With a Medicare Advantage Plan, members still have the same rights and protections as those detailed in Original Medicare, which includes the right to appeal. Always check with the plan before seeking treatments or services. Ask whether the service will be covered and what it will cost. In addition to this, always be sure to follow plan rules. For example, if the plan specifies that a referral is needed to see a specialist, be sure to get a referral. If approval is needed for certain procedures, be sure to obtain it. Failing to follow the rules will result in much higher costs. It's possible to join a Medicare Advantage Plan with a pre-existing condition. However, those who are in the last stage of renal disease don't qualify. There are only certain times during the year when enrollment is open. In most cases, individuals are enrolled for one year in a plan. Services obtained by health practitioners at facilities that aren't approved won't be covered in most cases. In some cases, partial amounts are covered. However, charges will always be higher. If the plan decides to drop Medicare participation, individuals will have to find another health plan to join or use Original Medicare.

How to Enroll In a Medicare Advantage Plan. Since these plans aren't all the same, it's important to invest some time in comparing Medicare Health Plans in the area. Be sure to read and understand the plan's rules and costs before joining. Medicare offers information about plan quality to help interested applicants compare plans. There are several different ways to join. Applications are usually accepted by mail, over the phone or through a plan sponsor's website.

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