Part C Plans

Beginning October 1st, CMS requires the following disclaimer on all agent websites

We do not offer every plan available in your area. Any information provided is limited to plans we do offer in your area. Please contact Medicare.gov or call 1-800-MEDICARE to get information on all your options.

Seniors have choices to make when it comes to shopping for Medicare plans. Medicare Advantage plans are one of those options.

Medicare Advantage plans are Part C plans. They are also referred to as MAPD plans, which stands for Medicare Advantage Prescription Drug plan. Medicare of course has four parts. Part A and Part B is original Medicare, Part D is the prescription drug plans and Part C is the Medicare Advantage plan program.

There are several types of Medicare Advantage plans but the most well known are HMO and PPO plans. HMO stands for Health Maintenance Organization. These plans are network based so you must use network providers. If you don’t the plan will not pay except in an emergency. PPO stands for Preferred Provider Organization. These are also network based plans but with these you can access out-of-network providers. Doing so will generally cost you more and often raise your plan’s out-of-pocket maximum.

Other Part C plan types are Special Needs plans. There are some specifically for people on Medicare and Medicaid. Those plans are called Dual Special Needs plans or DSNP’s. There are also Chronic Special Needs plans. Those are plans specifically designed for people with certain chronic illnesses such as COPD or chronic heart disease.

Medicare Advantage plans are not found everywhere. You will see more choices in areas with larger populations of people. You must live in the service area of the plan in order to enroll in it. And there are certain times of the year and certain exceptions on enrolling into those plans.

The Center for Medicare and Medicaid Services (CMS) is the organization that regulates all Medicare plans and marketing activities relating to those plans.

Medicare Advantage plans have been described by some as all-in-one plans. Most have 3 general areas of coverage. Medical Benefits, which is Part A and Part B services. Benefits and Services Beyond Original Medicare. These are the extras like routine dental, vision, hearing, and heath club membership that are included with many plans. And finally Prescription Drugs section. This is the Medicare Part D drug plan included as part of most Medicare Advantage plans.

Medicare Advantage plans are year to year contracts between an insurance company and Medicare.

Advantage plans are basically 3rd party insurance that is being outsourced to an insurance company by Medicare.

When you have a Medicare Advantage plan, and you go to the doctor or hospital, you will present your Advantage plan card and not your Medicare card.

This is because Medicare is paying the insurance company to manage your healthcare for them.

We have covered the basics here and you probably still have questions.

Give us a call and we would be glad to answer your questions or meet with you at our office or at your home.