Medicare Part C: a Primer on Medicare Advantage

To be eligible for Medicare Advantage, seniors must be enrolled in both Medicare Part A and Part B and live within the plan’s service area. As with any Medicare plan, no one may be denied coverage due to pre-existing conditions. For Medicare Advantage, this now includes end-stage renal disease (kidney failure). Until recently, people with kidney failure could get coverage only through original Medicare.

According to the AARP, more than 40 percent of Medicare beneficiaries choose to get their health and drug coverage through a private Medicare Advantage plan, rather than from Original Medicare.

There are three enrollment periods in which senior citizens may enroll, change or drop their Medicare Advantage plan.

The Initial Enrollment Period allows seniors to enroll in Medicare Advantage immediately after signing up for Original Medicare. Again, this begins 3 months prior to one’s 65th birthday and ends three months after.

The primary Medicare Advantage enrollment period is during Open Enrollment, which begins October 15th and ends December 7th. During this period seniors may enroll, switch or drop their Medicare Advantage plan (returning to Original Medicare). This is the same period most Americans choose their private healthcare plan.

Finally, there is the Medicare Advantage Open Enrollment Period, which begins January 1 and extends through March 31 each year. Any senior enrolled in Medicare Advantage may switch to a different plan during this period or go back to Original Medicare. Beneficiaries can only switch once during this period (they cannot go back and forth between plans; they can pick only one).

There are several types of Medicare Part C plans.

Health Maintenance Organization (HMO) plans: Beneficiaries choose a primary care doctor and must see in-network providers, except for emergencies or urgent care.

Preferred Provider Organization (PPO) plans: These plans offer more flexibility in choosing healthcare providers, with lower costs for in-network providers and higher costs for out-of-network providers.

Private Fee-for-Service (PFFS) plans: These plans allow beneficiaries to see any Medicare-approved healthcare provider that accepts the plan’s payment terms.

Special Needs Plans (SNPs): These plans cater to specific groups of people with certain health conditions or financial limitations.

Medical Savings Account (MSA) plans: These are high-deductible health plans combined with a bank account that can be used to pay for healthcare services.

As with any private health plan, the costs of Medicare Advantage plans vary widely depending on the beneficiary’s healthcare needs and coverage. Seniors will need to pay the Medicare Part B premium, along with any additional premiums required by the Part C plan. Other costs such as deductibles and copayments will also vary depending on the policy.

Fortunately, Medicare Part C plans have an out-of-pocket maximum, which caps the amount of out of pocket spending the beneficiary must spend on their healthcare every year.

If you are considering a Medicare Advantage plan to obtain additional benefits such as prescription drug coverage, dental or vision, but are unsure if a policy fits within your budget or may be right for you, give Insurance Professionals of Arizona a call immediately. Don’t try to navigate the countless Medicare plans in Arizona on your own.

Our Medicare experts can help you find exactly the coverage you need, while working with our partners to ensure your premiums and any other out of pocket expenses are within your budget.

We also understand the fine print and can explain every policy in your area in detail, so you know exactly what to expect. It doesn’t cost you anything to work with a Medicare professional, so there’s no sense taking chances with your healthcare. Give IPA’s Medicare office a call today at 480-331-7974.