Medicare
Part C, also known as Medicare Advantage, is a health insurance plan offered by
private insurance companies that have been approved by Medicare. Advantage
plans give you the option to enroll in a single policy that contains the same
coverage as Medicare Parts A and B, as well as prescription drug coverage.
With so
many parts and plan options, Medicare can be confusing. We’ll explain
everything you need to know about Medicare Advantage plans, and whether they’re
right for you.
How Is Medicare Part C Different from the Other Parts of Medicare?
A major
difference between Medicare Advantage (Part C) plans and Original Medicare
plans is the insurance providers. While the U.S. government provides the
coverage on Original Medicare plans, Medicare Advantage plans are offered by
private insurers who are vetted by the government.
Medicare
Advantage plans and Original Medicare also differ in coverage.
Original Medicare consists of Part A, B, and D. Part A covers inpatient
services like hospitalization or care in a skilled nursing facility. Part B
covers outpatient care such as routine doctor visits, lab tests, and
preventative care. Part D provides coverage for prescription drugs.
Medicare
Advantage plans provide the same coverage as Part A and Part B, as well as
prescription drug coverage that varies with each plan. Since private insurers
offer Medicare Advantage plans, drug formularies vary.
Some
Part C plans can also provide additional vision and dental benefits that may
not be covered by Original Medicare. They may even give you extra wellness
benefits like discounted gym memberships.
Is Medicare Advantage Right for Me?
Individual
needs vary, so it’s important to compare your health insurance options and
choose the coverage that is right for you. Here are some of the benefits of
Medicare Advantage plans:
·
Same coverage as Medicare Part A and Part B.
·
Added benefits such as prescription drug coverage, dental, and
vision (varies by plan).
·
Care coordination; under certain Part C plans, you can designate
a Primary Care Physician (PCP) to help coordinate your care. Certain plans also
provide medication therapy management.
Overall,
a Part C plan offers more comprehensive coverage in one plan. If you were to
enroll in an Original Medicare plan, you would have to elect for Part D
prescription drug coverage separately, and dental and vision care would be
limited.
However,
there are a few drawbacks to Medicare Advantage plans, including:
·
More limited provider networks
·
Special authorization or referral requirements
While
Original Medicare plans allow you to see any provider who accepts Medicare, a
Part C plan requires you to see a provider in that plan’s specific network. The
Part C provider networks are usually regional, not national like Original
Medicare. Additionally, your Part C plan may require you to obtain prior
authorization for certain medical procedures or get a referral from your PCP to
see a specialist.
Medicare Supplement Insurance
You may
have heard about Medicare Supplement Insurance,
or Medigap. Like Medicare Advantage plans, Medigap is offered by private health
insurance providers.
However,
Medigap requires you to maintain Medicare Part A and Part B coverage. In fact,
it is illegal for you to purchase Medicare Supplement Insurance if you have an
Advantage Plan. If you currently have Medigap and are thinking of joining an
Advantage Plan, you should contact your insurance company to drop your policy.
A Medigap policy is meant to help cover additional healthcare costs that Original Medicare does not, like:
A Medigap policy is meant to help cover additional healthcare costs that Original Medicare does not, like:
·
Deductibles
·
Coinsurance
·
Copayments
As a
supplement to Original Medicare, you must pay a separate monthly premium for
your Medigap policy. This payment is made to the private insurer issuing the
policy.
It is
important to note, Medigap policies are supplemental and only offer limited
coverage. For example, policies may not cover:
·
Prescription drugs
·
Vision or dental care
·
Most long-term care
·
Private-duty nursing
In this
regard, Medicare Advantage plans offer the benefit of an all-in-one
comprehensive policy.
Can I Be Turned Down For A Medicare Advantage Plan?
In
general, if you are eligible for Medicare Parts A & B, then you will not be
denied coverage by Part C. Patients with pre-existing medical conditions are
also still eligible for Medicare Advantage plans. The only exception is for
End-Stage Renal Disease (ESRD).
Individuals
with ESRD may be ineligible for most Medicare
Advantage plans. However, certain Special Needs plans may still
provide coverage.
Medicare Advantage Plan Costs
Monthly
premiums for Medicare Advantage plans can range from $0 to more than
$300. Premiums vary between plans and
even by location. However, when comparing plans, it’s important to
consider more than just premiums.
For
example, while some plans may have a $0 premium, copays and deductibles for
these plans can be much higher than in plans with more expensive premiums.
Always compare all the costs of a plan and make sure that it meets your
healthcare needs.
Medicare Advantage Plan Prescription Drug Coverage
While
many Medicare Advantage plans include prescription drug coverage, drug
formularies vary across plans. This means co-pays may differ and not all drugs
will be covered by your plan.
If your
medication is not covered by your Medicare Part C policy, or the co-pay is too
high, ScriptSave WellRx may be able to help you save. Our drug price comparison tool lets you check prices
at multiple pharmacies in your area. You can also get a free prescription
discount card to help you save at the pharmacy.
References:
https://news.wellrx.com/2020/02/13/what-you-need-to-know-about-medicare-part-c/
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