Medicare Advantage (PART C)

What is Medicare Advantage? What is Medicare Part C?

 

Medicare Advantage (MA), also known as Medicare Part C, is a health insurance program that provides an eligible person with the United States’ Medicare benefits. Medicare Advantage plans differs from the original Medicare model, which offered a standard plan provided directly by the state.

The term originated with the passage of the Balance Budget Act of 1997, which offered Medicare beneficiaries this option, instead of receiving these benefits through the original Medicare Plan (Parts A and B). These programs were known as Medicare+Choice or Part C plans.

Medicare Advantage plan features:

  • Offered from private insurance companies
  • Traditional come as an HMO or PPO insurance
  • Plan premiums are little to no cost at all
  • Generally, these plans include Part D Drug coverage at no additional cost.
  • Works in place of your Medicare, your Medicare benefits get redirected through the private insurance. The private is then responsible for 100% of your health care, not 80/20 like Medicare
  • Medicare Advantage plans are required to offer benefits as good as Medicare, if not better. Ei, discounts on dental, vision, hearing and sometimes gym memberships and more.

With Medicare Advantage plans, your Medicare benefits get redirected through a private insurance which is required to cover you just as good as Medicare benefits or better.

Instead of Medicare being responsible for 80% of your hospital and medical coverage and you being responsible for the other 20% plus deductibles (or having to buy an expensive supplement to cover the difference) Medicare Advantage plans are funded a set amount per member per month for your care. The private insurer (Medicare Advantage plan) is then responsible for 100% of your hospital and medical coverage.

Medicare advantage plans in Florida

In Florida, most common Medicare Advantage plans come either as a HMO insurance plan or a PPO insurance plan.

HMO = Health Maintenance Organization

  • Defined network
  • No out of network benefits (except for Emergency and Urgent care)
  • Referrals are required to see specialist (except for chiropractic, vision and well women exams)
  • Normally these plans are limited to a state or geographic region (counties) for scheduled care

PPO  =  Preferred Provider Organization

  • Defined network
  • Out of network benefits are generally available
  • No referrals required
  • Normally these plans cover you statewide or nationwide for scheduled care

 

Medicare Part C costs

The cost for a Medicare Advantage plan can be as little as $0 monthly. The reason why these plans have no premium is because Medicare funds the private insurance company a set amount of money monthly for your care regardless whether you use your insurance or not. By doing this, the company makes money on some and loses on other. It’s the law of large numbers and large insurance companies are very well versed in this category.


SHOP ADVANTAGE

If you would like assistance on narrowing down YOUR options, contact me directly at 321.947.3810 for personalized assistance.

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