50+ Lifestyles

About Medicare Advantage Plans (Part C)

By Richard J. Schillig, CLU, ChFC, LUTCF
Independent Insurance and Financial Advisor

We remain in the Medicare Advantage Open Enrollment until the end of this month. This enrollment period is a special enrollment period designed for Medicare folks who already are enrolled in an Advantage Plan.

Let’s review Advantage Plans. Medicare Advantage Plans (such as an HMO or PPO) are another way of obtaining Medicare coverage. Under an Advantage plan, you continue to receive Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Medicare Advantage Plans sometimes called “Part C” or “MA Plans,” are offered by private insurance companies that are approved by Medicare.

We remain in the Medicare Advantage Plan Enrollment Period until the end of this month (March 31). The Medicare Advantage open enrollment period runs from January 1 to March 31, and allows Medicare Advantage enrollees to either switch to Original Medicare (plus a Part D plan) or switch to a different Medicare Advantage plan.

Medicare Advantage Plans cover all Medicare services. There are many Medicare Advantage Plans to choose from in these Medicare areas, but in all plans, you are covered for all the services that Original Medicare covers (including emergency and urgent care), except for hospice care – and some care in qualifying clinical research studies. However, hospice care and some costs for clinical research studies are coverage by Original Medicare, even if you are in a Medicare Advantage Plan. Medicare Advantage Plans may offer additional modified coverage like vision, hearing, dental and wellness programs. Most Advantage Plans include Medicare prescription drug coverage (Part D).

Medicare Advantage Plans must follow Medicare’s rules and regulations. Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you receive series (like whether you need a referral to see a specialist; or if you have to go to a network of doctors, facilities or suppliers that belong to the plan for non-emergency or non-urgent care. These rules can change each year. The plan must notify you about any changes before the start of the next enrollment period.

Remember there are two main ways to get your Medicare coverage – Original Medicare or Medicare Advantage. Original Medicare – called the 3 card system – includes first the Medicare card with Part A & B offered by the federal government. Private insurance companies then provide the Medicare Supplement Plan with a separate card and Prescription Drug plan is included in most Advantage Plan providing the 3rd card. The alternate to Original Medicare and the 3 card system is the Advantage Plan – the one card system.

There are pros and cons to each system. Our monthly Community Meetings are structured for the 3 card system on Tues March 24 and the 1 card system on Thursday, March 26.