Medicare Advantage (Part C)
If you are eligible for Medicare and you are looking for the least expensive option, then Medicare Advantage might be the right choice for you. Medicare Advantage plans are mostly HMO options and usually offer the lowest pricing available.
Medicare Advantage is referred to as Part C. These plans cover most of what is normally included in Part A (in-patient hospitalization) and Part B (out-patient doctor visits). Also, they often include Part D (prescription drugs).
On the other hand, Supplemental Plans allow you to add additional coverage to Parts A and B. Supplemental Plans tend to have more doctors available and allow a wider variety of procedures, but they do also tend to have higher monthly premiums than the Advantage Plans.
Is Medicare Advantage available in my area?
What is the Network like?
Medicare Advantage plans have a network of doctors to choose from. It may be an HMO, PPO, or POS network. Supplement plans, on the other hand, do not have a network.
PPO Advantage Plans may restrict members to receiving care only in their county. This can be an issue if you live close to the county line and wish to see doctors in a neighboring county.
What are the basic coverage benefits on a Medicare Advantage plan?
Medicare Advantage Plans include clinic benefits. Also, most of your inpatient hospitalization, home health care, skilled nursing facility, and hospice that are normally included in Part A will be included in your Part C Advantage Plan. In addition, the Medicare Advantage health insurance benefits include:
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These plans must include an out-of-pocket maximum. This is your worst-case scenario, or your total liability. If you received a $200,000 hospital bill, how much of that expense would you have to pay? Once you have reached the OOP Max, the health insurance carrier picks up the remainder of your qualified medical expenses for the rest of the calendar year. The OOP Max could be between $700 and $11,000. An average OOP Max would be around $3,000 – $4,000.
Be aware!
- Medication expenses do not add toward the maximum out of pocket and are not subject to it.
- Medicare Advantage plans can restrict treatment options. For example, in one area of Nevada, a consumer found that Proton Radiation Therapy for prostate cancer was not included by any of the Medicare Advantage options. However, the consumer was able to get this treatment included with a Supplement Plan.
What ancillary benefits may be available through a Medicare Advantage plan?
Most Part C insurance plans include additional ancillary benefits above and beyond what Medicare covers:
- Ancillary benefits that may be included automatically: vision, gym memberships, chiropractic, acupuncture, free fit bit, therapeutic massage, OTC medications, a discount towards weight loss programs, hearing aid coverage, travel assistance coverage, dental (usually an HMO dental plan with minimal coverage), membership to Brain HQ (mental acuity exercises/games which can help you avoid dementia and improve your memory, cognitive speed, and clarity)
- Optional ancillary benefits that you may be able to add at an additional cost: dental or vision upgrades
Preferred Provider Organization (PPO) Plans: A type of plan that has a network of preferred providers from which you can choose. Your plan may assign a primary care provider to assist in coordination of care. However, the member may still coordinate their own care and can see any provider within the network without a referral. Members can also see providers outside the network, but at a higher cost.
Once you arrive at the OOP Max, then you have 100% coverage for included benefits and these benefits are free for you. You pay $0 for included benefits once you reach the Out-of-Pocket Maximum. The OOP Max resets every year on January 1st. The OOP Max for the Bronze and Silver Plans is $7,550. It is $7,200 for Gold Plans and $3,350 for Platinum Plans.