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Medicare Advantage – Medicare Part C

Medicare coverage plans can become a bit complex and costly when you need a more in-depth service. That is why Medicare Part C is a hybrid coverage plan that includes Part A and Part B. This means that hospital insurance and medical insurance are included in this fusion program. A combination of the two allows you to have all the drug and health benefits you need within a single healthcare plan instead of a stand-alone plan. This allows for several cost-effective options for you to choose from and additional unique benefits not offered in other programs.

If you have more questions, work with a licensed representative who can help you get started on your Medicare Part C plan. Contact the Insurance Professionals of Arizona today to review your options.

Comparison of Medicare Part C Plans 

Learn how a Medicare Part C Plan can work for you. As an alternative to Part A and Part B, Part C helps you gain the benefits of both programs. 

Is Medicare Part C the same as Medicare Advantage?

Medicare Advantage and Medicare Part C are considered the same program. Both allow the convenience of having both the drug benefits and health facility care coverage within a single plan. This is a better alternative than the option of enrolling into the Medicare Prescription Drug Plan, which is an entirely different program for the purpose of covering prescription drugs. There are also extra benefits, such as dental coverage, health wellness programs, hearing and routine vision check-ups. This is something the original Medicare plan does not include. Beneficiaries must enroll through the Medicare Advantage plan with private insurance companies. All of these companies are contracted with Medicare. The Medicare Advantage plans have to provide the same coverage that an Original Medicare plan would cover, and Part A and Part B. This doesn’t include hospice care in Part A, however. To be eligible, you must be within the service area of the Medicare Advantage plan you want to enroll in. You have to be enrolled in Part A and Part B. Unless there is an exception, you cannot have end-stage renal disease to qualify.

Are Medicare Advantage Plans Bad?

While they have great flexibility, they often end up pricier than other programs. There is the possibility of unplanned out-of-pocket expenses that can occur. There are a lot of copay costs that can add up over time if you happen to fall ill. You save a lot when doing well health-wise. However, if you happen to get a very serious medical illness, then you will have to purchase medicines and services through the copay option. The only time you are able to switch back to the Original Medicare plan is during the Medicare open season. 

Urgent care may not always be available due to rationing; there is also less flexibility regarding which hospital or doctor you can choose due to rationing. Some plans that have prescription drug coverage may ration high-cost medications. 

It may be hard to receive coverage when not in your local region, where benefits aren’t as promised. Additionally, these plans are not always financially stable. That is because individual private companies have their own problems and sometimes abruptly stop coverage. If a company suddenly becomes insolvent, then the enrollees will have no one to provide for them. All enrollees have to follow the strict rules of the plan to receive coverage. These plans sometimes drop providers without notice and may also only be able to cover specific doctors. 

What are four types of Medicare Advantage plans?

The most common types of Medicare Advantage Plans include the Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Private Fee-for-Service (PFFS), and Special Needs (NSPs) plans. These are the most popular but not the only kind of plans available as some private insurance companies provide more specialized options for applicants with unique needs. 

Preferred Provider Organization 

The PPO plan is offered by a private insurance company where there is a network of doctors and hospitals. If you use one of the doctors within this network, it costs a lot less. When you use a doctor outside of the network, it costs far more. Prescription drugs are typically covered in PPO plans. 

Health Maintenance Organization

For an HMO plan, you receive services for providers except when it concerns an out-of-area urgent care service, an out-of-area dialysis, and emergency care. Some coverage plans may include out-of-area services, but it costs less when working with your network of providers. 

Private Fee-for-Service 

This plan is offered by a private insurance company but is much different from the Original Medicare plan and Medigap. In this plan, it is pre-determined how much in costs will go to doctors and hospitals. You decide how much you will pay when you receive care. While you can see any provider, the costs will be less if you work with a network provider. You can also go to any Medicare-approved doctor who will accept your payment plan terms. Prescription drugs might be covered, or you can join a Medicare Drug Plan with Part D coverage.

Special Needs Plan

This plan limits membership, and only people with unique diseases or characteristics can join. The drug formularies are more extensive and meet the needs of the individuals covered under these plans. You won’t be able to receive urgent or emergency care. Out-of-area dialysis is not covered under this program either. 

Get Started on your Medicare Advantage Part C Medical Coverage

To further review your options, you can work with a licensed representative who can guide you on the next steps. Review your medical coverage options and find out which is the most cost-effective plan for you. To make the process easier, you can contact the Insurance Professionals of Arizona today to get started. 

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