Medicare Advantage Plans: Part C

Today there are alternatives to the traditional structure of the original Medicare plan coupled with Medicare Supplement insurance. The Balanced Budget Act of 1997 authorized the use of alternative health care plans, including some types of managed care plans to provide Medicare benefits. The goals were to give Medicare beneficiaries more health care plan options and to help control Medicare costs. The new alternative program was known as Medicare+Choice, or Medicare Part C. Then in 2003, the Medicare Prescription Drug, Improvement, and Modernization Act made additional refinements to the Medicare+Choice program and renamed it Medicare Advantage. Plans available under the Medicare Advantage program include Private Fee-for-Service Plans, Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Special Needs Plans(SNP), and Medical Savings Accounts (MSA).

Medicare Advantage Considerations

Medicare Advantage Plans are are optional health plans approved by Medicare and run by private companies. These plans must follow rules set by Medicare, and are an option to original Medicare, rather than supplements to your coverage. Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) benefits and must cover at least all of the medically necessary services that the original Medicare Plan provides. This coverage can include Medicare Part D prescription drug coverage, or you can enroll in a separate Part D prescription drug coverage plan. Medicare Advantage  plans can charge different copayments, deductibles, and coinsurance for these services. In many cases there are extra benefits and lower copayments than in the original Medicare Plan. However with PPO and HMO plans you may need to see doctors that belong to the plan or go to certain hospitals for services to avoid higher out-of -pocket expenses. PFFS plans allow you to see any health care provider, as long as they agree to accept the plan's terms of payment before treating you. Some Medicare Advantage Plans have $0 premium plan options, and may even reimburse you for part of your Medicare Part B premium. Extra benefits can include dental,  vision, and health club memberships.

Who Can Join a Medicare Advantage Plan?

You can generally enroll in a Medicare Advantage plan if you have Medicare Part A and Part B, you live in the service area of the plan, and you do not have End-Stage Renal Disease. You must still pay the monthly Part B insurance premium and may also have an additional premium for the Medicare Advantage plan. People who are enrolled in Medicare Advantage plans do not need a Medicare supplement policy since Medicare Advantage plans typically provide most of the same benefits that are provided by Medicare supplement insurance.