What are Medicare Advantage Plans (Part C)?

  • Medicare Advantage Plans are another way for beneficiaries to get their Medicare part A & B benefits. It’s ALTERNATIVE coverage so instead of having Original Medicare Parts A & B as your primary insurance the Advantage plan becomes primary.
  • Advantage plans are NOT Medicare Supplement Plans (Medigap); They’re COMPLETELY DIFFERENT!
  • Medicare pays a private insurance company a fee every month for the company to administer your Part A & B benefits.
  • You will pay deductibles, copays, coinsurance up to the plan’s out-of-pocket-maximum
  • Additional rules apply such as using doctors/hospitals within the provider network
  • If you want to see a doctor/specialist/hospital outside of the network you may pay higher costs or not be covered at all
  • Many Advantage plans provide part D drug benefits (sometimes have higher out of pocket costs)
  • HMO plans are the most popular Advantage plan. They require you to have a PCP to coordinate your benefits and require referrals before seeing specialists. PPO plans allow you to see out-of-network doctors/hospitals but you will pay higher out-of-pocket costs.
  • Enrollment in an Advantage plan means that you are required to stay on that plan for one year (Jan-Dec)
  • You can only make changes to your plan during AEP or OEP unless you qualify for an SEP. Check to see if you qualify for a Special Enrollment Period by calling Medicare Sharks!

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When can I change my Medicare Advantage Plan (Part C)?

In most cases, you must keep your Medicare Advantage Plan for the full year Jan-Dec. During the Annual Enrollment Period (Oct 15 – Dec 7) you can make changes to your Medicare Advantage Plan and coverage will start Jan 1. There’s another opportunity to make changes to your Advantage Plan during the Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31). However, you may be entitled to a Special Enrollment Period (SEP) where you can change your plan mid-year. It’s always a smart idea to check with the Medicare Sharks licensed experts to see if changes to your Medicare Advantage Plan would benefit you!

I was told that Medicare Advantage Plans are “FREE” or “No-Premium/Low-Premium”?

Although, some Advantage Plans may have a zero-dollar monthly premium, there are many out-of-pocket costs associated with Advantage Plans. Every Advantage Plan has a maximum-out-of-pocket amount, so it stands to reason that there are costs associated with Advantage Plans which you have to pay. Maximum-out-of-pocket costs can range anywhere from $3,400 to $6,700 to $10,000 and each carrier’s plans are completely different. There are copays for doctors’ visits and even higher copays for specialists. There are deductibles for things like hospitalization. You’ll pay coinsurance for lab tests, blood work, X-rays, MRIs, CAT Scans, ambulance rides, chemo drug, and most procedures.



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