Medicare Advantage – Medicare Part C

Medicare Part C – Medicare Advantage Plans

If you are eligible for Medicare, you have two options. You can get Original Medicare (Part A and Part B) through the government or you can get Medicare Part C. Medicare Part C, also known as Medicare Advantage, is issued by private insurance companies that Medicare has approved. Learn more about Medicare Advantage plans in 2020.

What Is Medicare Advantage Part C?

Medicare Part C plans are required to provide at least the same amount of coverage you can get with Original Medicare. If you had Original Medicare, Part A and Part B would work separately. You would also need to get Medicare Part D if you want prescription drug coverage. Medicare Part C plans are bundled. That means that Medicare Part A and Part B are part of the same policy.

Some companies offer additional coverage as well. This is referred to as supplemental benefits.

What Does Medicare Part C Cover? Understanding Supplemental Benefits

If you are searching for Medicare Part C in 2020, it’s critical to consider the supplemental benefits provided by some plans. Along with offering Medicare Part A and Part B, many plans include extras that make this coverage more enticing.

Medicare Advantage Prescription Drug plans are very popular. These plans bundle Medicare Part D with Parts A and B. You can also find plans that cover:

  • Routine dental.
  • Routine vision.
  • Routine hearing.
  • Wellness benefits.
  • In-home personal care services.
  • Social worker phone access.
  • Nicotine replacement therapy.
  • Home safety medications.
  • Adult day care.
  • Additional days for inpatient hospital stays.
  • Additional days at skilled nursing facilities.

These are just some of the benefits available. Private insurance companies choose which benefits to provide.

The number of supplemental benefits available will increase in 2020 due to the passage of the Bipartisan Budget Act of 2018. This act allows Medicare Advantage plans to offer benefits for chronically ill members that aren’t primarily health-related.

How Much Does Medicare Advantage Cost?

Most Medicare Advantage plans charge a monthly premium. The average premium in 2018 was $29.81, and premiums have been decreasing. Some companies also offer zero-premium plans. However, these plans often have higher out-of-pocket costs. It’s important to look at the premiums, out-of-pocket costs, and coverage when choosing a plan.

Medicare Part C in 2020 – Available Plans

If you were to get Original Medicare, you would not choose a plan. You would simply have Original Medicare. However, Medicare Advantage plans are similar to private health insurance plans. You can choose the type of plan you want. Keep in mind that plan availability depends on where you live.

Health Maintenance Organization (HMO) Plans

Medicare Advantage HMO plans work the same way as standard HMO plans do. You will have access to a network of providers and will only receive coverage if you stay within the network. The exception is if you need emergency care. Also, if you need to see a specialist, your primary care doctor will need to refer you.

Preferred Provider Organization (PPO) Plans

PPO plans give you access to in-network and out-of-network providers, although your coinsurance costs will be lower if you stay inside of the network. You do not have to get a referral to see specialists with this type of plan.

Private Fee-for-Service (PFFS) Plans

PFFS plans work much like Original Medicare. The plan administrator determines how much it will pay for services. It will also determine how much you will owe. You can visit any provider who accepts the terms of the plan.

Special Needs Plans (SNPs)

If you have a special need such as a chronic health condition, you might want to choose an SNP. These plans often have special formularies and coverage option to address the health needs of certain groups of people.

HMO Point-of-Service (HMOPOS) Plans

HMOPOS plans also have a network of providers. However, you can get some services outside of the network as well. You will pay higher coinsurance and copayments when you go outside of the network.

Medical Savings Account (MSA) Plans

You will need to get a high-deductible health plan with your MSA. Medicare will put money into a special medical savings account for you, but the money deposited is typically less than the deductible. You can get money out of the account to pay for your healthcare needs. It is important to note that MSAs do not include prescription drug coverage, so you will have to buy a separate plan to avoid high out-of-pocket costs.

How to Enroll in Medicare Part C in 2020

You can enroll in Medicare Advantage during an enrollment period. The Initial Enrollment Period (IEP) starts 3 months prior to the month you become 65 and finishes three months after. If you are under 65 and eligible due to a disability, you can enroll 21 months after you receive your disability benefits and ends seven months later.

Medicare Open Enrollment will occur from Oct. 15 to Dec. 7, 2020. You can change from Original Medicare (Part A and Part B) to Medicare Advantage during this time. A change to a different Medicare Part C plan is also possible if you already have Medicare Advantage.

If you already have Medicare Advantage and want to make some changes, you can do so during the Medicare Advantage Open Enrollment Period. This period is on Jan. 1 – March 31, 2020. You cannot go from Original Medicare to Medicare Advantage during this time, but you can change from one Part C plan to another. You can also switch back to Original Medicare if you wish.

Finally, you might be eligible for a Special Enrollment Period. If you experience a life change such as losing insurance coverage, you can enroll during this period.

Choosing a Medicare Part C Plan in 2020

There are lots of Medicare Advantage plans available in 2020, and that makes it difficult to make a decision. Fortunately, a licensed insurance agent can help. Let an insurance agent help you compare plans so you can find a fair price and the right amount of coverage for your specific needs.