If you’re going to be eligible for Medicare health care insurance soon, you might be in the process of weighing your coverage options. Is enrolling in Original Medicare Parts A and B right for you? Or should you consider enrolling in a Part C Medicare Advantage plan?
It’s a fact that Medicare Advantage plans have been steadily gaining popularity over the past few years. Today, there are over 26 million people enrolled in Medicare Part C. This means that around 42 percent of all Medicare beneficiaries in this country have chosen Medicare Advantage plans for their coverage.
Deciding between Original Medicare and Medicare Part C coverage depends on what is best for your individual health care needs and your budget. That’s why it’s important to have as much information as possible, and this article can help you get to know more about Medicare Part C and whether it is a better choice for you.
What is Medicare Part C?
Medicare Advantage (Part C) plans are available for eligible Medicare beneficiaries to purchase from private insurance companies. Selling Part C plans isn’t mandatory, it’s an option that companies can choose to do. The federal Medicare program maintains oversight over all Part C plans and subsidizes the insurance companies to provide Medicare coverage for their enrollees.
All Medicare Advantage plan providers are required by law to provide all the benefits that are included in Original Medicare Parts A and B. These benefits include inpatient hospital, skilled nursing, and hospice care, as well as medically necessary outpatient medical care, certain medical supplies, and preventive care services.
Many Medicare Advantage plans also bundle prescription drug coverage together with mandatory inpatient and outpatient care services. Having Medicare Part D benefits all in one plan is advantageous for many. Because Part D benefits are optional coverage, each plan has its own list of drugs it covers, known as the plan’s formulary. You should review a plan’s formulary if this type of coverage is offered with your Part C plan.
Today, most Medicare Advantage plans also offer extra benefits that aren’t included in Original Medicare benefits to make them more attractive for beneficiaries. These extra benefits may include routine dental, vision, hearing care, and fitness club memberships. Some plans even have monthly allowance cards for over-the-counter medications.
Depending on the plan and provider you choose for your Part C coverage, you may pay one monthly premium for all benefits. Other plans may have additional monthly charges for the additional benefits. Make sure you discuss these charges with the prospective insurance provider before signing up.
It’s also important to remember that depending on the type of Medicare Part C plan you enroll in, you may be required to use a set network of providers for your health care services and supplies.
What types of Medicare Advantage plans are there?
Health Maintenance Organization (HMO) plans
HMOs usually require that you receive health care services from physicians, hospitals, and other medical facilities that are within the plan’s network to get full benefits. Some HMOs allow out-of-network care for a higher out-of-pocket cost, which is called a point-of-service (POS) option.
Beneficiaries are also required to get a referral from their primary care provider for visits to specialists.
Preferred Provider Organization (PPO) plans
PPO plans also have network providers, and beneficiaries pay less when they use these providers. PPOs give enrollees the option to use providers that are outside the network, but the services carry additional costs. PPOs don’t require beneficiaries to choose a primary care physician, and they don’t require referrals to see specialists.
Private-Fee-For-Service (PFFS) plans
PFFS plans allow beneficiaries to get health care from any doctor or hospital that works with Medicare if they agree to the payment terms of the plan. PFFS plans typically have higher costs, but if the option for access to out-of-network health care providers is better for you, they may be worthwhile. Some PFFS plans also include prescription drug coverage, but if not, you are eligible to enroll in a stand-alone Part D plan too.
Special Needs Plans (SNPs)
SNPs are available for people with certain illnesses or disabilities. They are specially designed plans that offer medical services that are necessary for this group. SNPs all include prescription drug benefits. They also require that enrollees have a primary care physician or care coordinator and get referrals before seeing a specialist.