Medicare Part C (Medicare Advantage)

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Medicare Part C, also known as Medicare Advantage, is an alternative way to receive your Medicare Part A and Part B benefits. Private insurance companies approved by Medicare offers these plans and bundle your Part A, Part B, and often Part D (prescription drug coverage) into a single plan that replaces original Medicare. Let's take a closer look at Medicare Advantage plans and their key features.

What Do Medicare Advantage Plans Cover?

Medicare Advantage plans must cover all the services that Original Medicare (Part A and Part B) covers, except for hospice care, which is still covered under Part A. Many Medicare Advantage plans also offer additional benefits not covered by Original Medicare, such as:

• Prescription drug coverage (Part D)
• Routine dental, vision, and hearing services
• Fitness programs (like gym memberships)
• Health wellness programs

Types of Medicare Advantage Plans:

There are several types of Medicare Advantage plans, each with its own structure and rules:

• Health Maintenance Organization (HMO) Plans: In most HMOs, you can only go to doctors, specialists, or hospitals within the plan's network, except in an emergency.
• Preferred Provider Organization (PPO) Plans: PPOs allow you to visit out-of-network providers, but you'll typically pay less if you stay within the plan's network.
• Private Fee-for-Service (PFFS) Plans: PFFS plans determine how much they will pay for services and how much you must pay when you receive care.
• Special Needs Plans (SNPs): SNPs are designed for people with specific diseases or characteristics, such as those with chronic conditions or those living in a nursing home.

Costs Associated with Medicare Advantage:

Monthly Premium:

In addition to your Part B premium, you may have to pay a monthly premium for your Medicare Advantage plan. Some plans may offer a $0 premium, but you'll still need to pay your Part B premium.

Deductibles, Copayments, and Coinsurance:

Medicare Advantage plans may have different deductibles, copayments, and coinsurance than Original Medicare. These costs can vary depending on the plan you choose and the services you receive.

Maximum Out-of-Pocket:

One advantage of Medicare Advantage plans is that they have an annual out-of-pocket maximum. Once you reach this limit, the plan will cover 100% of your covered medical expenses for the rest of the year.

Enrollment and Eligibility:

To be eligible for a Medicare Advantage plan, you must:

• Be enrolled in both Medicare Part A and Part B
• Live in the plan's service area
• Not have End-Stage Renal Disease (ESRD) in most cases

You can enroll in a Medicare Advantage plan during your Initial Enrollment Period, the Annual Election Period (October 15 - December 7), or during Special Enrollment Periods if you qualify due to certain life events.

It's important to carefully compare Medicare Advantage plans in your area, as costs, benefits, and provider networks can vary significantly. When choosing a plan, consider your healthcare needs, budget, and preferred doctors. At Lakes Health Insurance we are licensed Medicare Insurance agent and can help you navigate your options and find a plan that best fits your needs.

Keep in mind that if you enroll in a Medicare Advantage plan, you'll receive your Medicare benefits through the plan, not Original Medicare. You'll also typically need to use healthcare providers within the plan's network to keep your costs as low as possible.