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Unpacking Medicare Part C: Could a Medicare Advantage plan be right for you?

Color portrait of Mark Pabst By Mark Pabst

Medicare Advantage Right For You

 

What is Medicare Advantage? Let's unpack what you need to know about Medicare Advantage. Sometimes it's just easier to get everything you need in one place. That's the idea behind Medicare Advantage, also known as Medicare Part C. It helps you make the most of one plan. These types of plans are provided by a private insurance company and include coverage for everything that original Medicare covers.


What is the advantage? Medicare Advantage plans can cover more. For example, many offer prescription drug coverage, as well as dental, vision and hearing benefits. Some include coverage for things like fitness memberships. Others even connect you to wellness coaches, either online or by phone to help you reach your health goals. If you choose Medicare Advantage, you continue to pay a monthly Part B premium to Medicare, in addition to any premiums you pay to the company that provides your plan.


Medicare Advantage plans can offer richer benefits at a more reasonable price, because they harness the power of coordinated care within a network of providers. But keep in mind not every doctor or hospital is part of your network, and if I a provider is outside your network, their services may not be covered. So, before you sign up for a Medicare Advantage plan, make sure the doctors you want are in the plan's network.


If you like the idea of being able to manage all your Medicare and prescription drug benefits under one plan, a Medicare Advantage plan might be for you. Got more questions? Learn more at Aetnamedicare.com.

There’s a lot to be said for being able to get everything you need under one roof. For starters, it’s more convenient. That’s the principle behind Medicare Advantage: a unique part of Medicare that pulls together many benefits, care options and costs into one plan. 

What is Medicare Advantage?

Medicare Advantage plans are provided by private insurance companies approved by Medicare. These plans are also known as Medicare Part C.  By law, every Medicare Advantage plan must include coverage for everything that Medicare Parts A and B, often called Original Medicare, cover. That means they include the same hospital and outpatient services. But Medicare Advantage plans may also cover more than Original Medicare.

Medicare Advantage is a unique part of Medicare that pulls together many benefits, care options and costs into one plan.

What does Medicare Advantage cover?

While plans vary, some additional benefits of Medicare Advantage plans include:

  • Dental coverage
  • Vision coverage
  • Hearing coverage
  • Fitness club membership

Some plans also include prescription drug coverage.

So, a well-chosen Medicare Advantage plan can come with all the coverage you get with Medicare Parts A, B and D. The additional coverage beyond what is offered by the other parts of Medicare is like the icing on the Medicare cake.

Unpacking Medicare Advantage Infographic

 

Part C

Medicare Advantage

 

What you need to know:

  • Annual out-of-pocket maximum
  • Can include Rx coverage
  • Often covers dental, vision, hearing and other benefits, such as fitness programs
  • Coverage provided through a private insurance company
  • Usually comes with a network of doctors and hospitals

What does choosing Medicare Advantage mean for your health care costs?

The costs may differ from the costs you pay with Original Medicare. Here are some of the main differences. 

Premiums

After you choose a Medicare Advantage plan, you’ll continue to pay a monthly Part B premium to Medicare. And you’ll sometimes pay a premium to the company that provides your plan. But there are some Medicare Advantage plans that don’t charge an additional premium.

Deductibles

While Original Medicare has standard deductibles, they can vary among Medicare Advantage plans.  And some plans don’t require you to pay a deductible at all.

Copayments

You may pay a smaller copayment – a set amount you pay for care – with Medicare Advantage for a doctor visit than they would under Original Medicare.

Firm limit on how much you pay for care

What happens if an unforeseen event or illness causes you to need a lot of medical care? Medicare Advantage plans come with a firm limit on how much you pay for covered medical care every year. That means once you’ve hit your limit for the year, you don’t pay any additional costs on covered medical services. Original Medicare doesn’t include this limit.

How do Medicare Advantage plans provide extra benefits at a reasonable price?

Medicare Advantage plans harness the power of care networks. These are groups of doctors and other health care professionals who contract with your plan. These networks help keep costs down. It also means your care may not be covered if you go outside your plan’s network. So before you sign up, make sure your favorite doctors are in a plan’s network.

It’s also important to remember that not all plans are alike. Two of the most common types are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). 

What’s the difference between an HMO and PPO plan?

Medicare Advantage HMO plans generally require you to stay within the network. And you may need to get referrals to see specialists. But, there are exceptions for emergency care or out-of-area urgent care. 

Medicare Advantage PPO plans generally have higher monthly premiums than HMO plans. But you have more flexibility to see doctors without a referral. And you may see health care providers outside your plan’s network.  You usually pay more if you do. 

Traveling with Medicare Advantage

If you travel regularly, make sure you’ll be covered if you need care while on the road. Medicare Advantage plans tend to have a service area. This means that particular plans are only available to people who live in specific areas. And networks of health care professionals may be restricted to the plan’s geographic area. But there are exceptions.

Some Medicare Advantage plans focus on more than one region. So if you summer in New England but winter in Florida, there might be a plan out there for you. Be sure to shop around to make sure there are in-network doctors in both places. Just because you travel regularly doesn’t necessarily mean Medicare Advantage isn’t for you.

Some perks of MA plans

Lifestyle coaching programs: talk with a health coach about how to reach goals like managing stress better, quitting smoking or improving your diet.

A multidisciplinary care management team: connect to the right resources, coordinate your benefits and ensure better orchestration of care.

Online tools and resources: look up guides to make healthy decisions and manage conditions. 

The three C’s of Medicare Advantage: cost, coverage and convenience

Medicare Advantage brings together the benefits of other parts of Medicare (plus a few added benefits) under a single plan. So it helps you with the three C’s: cost, coverage and convenience.

However, Medicare Advantage plans aren’t necessarily for everyone. You’ll need to shop around. See if a Medicare Advantage plan that fits your goals is available in your area.  

About the author

Mark Pabst has worked as a writer and researcher in the health care field for almost two decades. When not writing about health he tries to stay healthy through activities like hiking, climbing and paddling in the far flung corners of his native state of California. However, despite his best efforts he still has a few unhealthy habits he can’t shake, most notably a weakness for jelly donuts.

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