Part C, perhaps better known as Medicare Advantage, is one of the more confusing parts of the Medicare Alphabet. So far, we’ve covered Part A and Part B–the parts of Medicare commonly referred to as Original Medicare. Part C is where we start to depart from the government-facilitated side of the programs.
While Medicare Advantage plans are regulated by the federal government, they are not completely facilitated by the federal government as A and B are. Instead, Medicare Advantage plans are facilitated by health insurance companies–similar to how your employer plan or your individual health insurance plan may have been.
How do they work?
How does a Medicare Advantage/Part C plan work? Well, the simple answer is that it combines your Parts A and B (no, you can’t get rid of those, unfortunately) into one plan, and doctors/providers, instead of billing Medicare, will bill the health insurance carrier instead.
Maybe that’s not a simple answer, but that’s the simplest it gets!
How does it work for you?
If you’re like many of our clients, this is the real question you have. When you get your Medicare Parts A and B, you have two avenues. One is a Medicare Supplement/Medigap plan, and the other is a Medicare Advantage plan. We’ll compare these types of plans side by side in a later article. For now, you’ve chosen the Part C plan. What happens now?
Your Medicare Advantage plan functions similarly to a group or individual health plan. While each plan has different benefits, many do not have a deductible (see our article about health insurance terms here). Most also have a maximum out of pocket for how much you may spend on care for the calendar year. You may have a copayment to see a specialist or a primary care provider. You may have a cost share to get MRIs or other testing done, and you may have to stay in the carrier’s network of providers for these coverages to apply.
Many Advantage plans offer additional coverages such as acupuncture, chiropractic care, naturopathy, vision, dental, and some even have no-cost gym memberships included! These plans have a steady monthly premium determined at the beginning of the calendar year, and they do not increase as you age. With many plan premium options, there is usually a good fit for anyone looking into Medicare Advantage plans.
All of that is to say if you’ve been on an employer plan or an individual health plan up until receiving Medicare benefits, a Medicare Advantage plan will not be an earth shattering change in functionality. Always be sure to look at all of your options when researching Medicare. These articles are meant to be a quick helpful guide–not a comprehensive summary of what is available to you in your area. For a full list of what is available to you, contact us or another licensed agent, call Medicare, or go online to Medicare.gov!