Medicare Advantage (Part C)
Posted: July 07, 2022
If you are eligible for Medicare and you are looking for the least expensive option, then Medicare Advantage might be the right choice for you. Medicare Advantage plans are mostly HMO options and usually offer the lowest pricing available.
Medicare Advantage is referred to as Part C. These plans cover most of what is normally included in Part A (in-patient hospitalization) and Part B (out-patient doctor visits). Also, they often include Part D (prescription drugs).
On the other hand, Supplemental Plans allow you to add additional coverage to Parts A and B. Supplemental Plans tend to have more doctors available and allow a wider variety of procedures, but they do also tend to have higher monthly premiums than the Advantage Plans.
Is Medicare Advantage available in my area?
Medicare Advantage is not available in all areas. In some rural areas, there are few or no options. On the other hand, in urban areas like Los Angeles County there are 50 or more options. If you live in a more populated area, you will almost certainly have Medicare Advantage Part C options.
What is the Network like?
Medicare Advantage plans have a network of doctors to choose from. It may be an HMO, PPO, or POS network. Supplement plans, on the other hand, do not have a network.
PPO Advantage Plans may restrict members to receiving care only in their county. This can be an issue if you live close to the county line and wish to see doctors in a neighboring county.
What are the basic coverage benefits on a Medicare Advantage plan?
Medicare Advantage Plans include clinic benefits. Also, most of your inpatient hospitalization, home health care, skilled nursing facility and hospice that are normally covered by Part A will be covered by your Part C Advantage Plan. In addition, the Medicare Advantage health insurance benefits include:
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These plans must include an out-of-pocket maximum. This is your worst-case scenario, or your total liability. If you received a $200,000 hospital bill, how much of that expense would you have to pay? Once you have reached the OOP Max, the health insurance carrier picks up the remainder of your qualified medical expenses for the rest of the calendar year. The OOP Max could be between $700 and $11,000. An average OOP Max would be around $3,000 – $4,000.
Be aware!
- Medication expenses do not add toward the maximum out of pocket and are not subject to it.
- Medicare Advantage plans can restrict treatment options. For example, in one area of California, a consumer found that Proton Radiation Therapy for prostate cancer was not covered by any of the Medicare Advantage options. However, the consumer was able to get this treatment covered with a Supplement Plan.
What ancillary benefits may be available through a Medicare Advantage plan?
Most Part C insurance plans include additional ancillary benefits above and beyond what Medicare covers:
- Ancillary benefits that may be included automatically: vision, gym memberships, chiropractic, acupuncture, free fit bit, therapeutic massage, OTC medications, discount towards weight loss programs, hearing aid coverage, travel assistance coverage, dental (usually an HMO dental plan with minimal coverage), membership to Brain HQ (mental acuity exercises/games which can help you avoid dementia and improve your memory, cognitive speed and clarity)
- Optional ancillary benefits that you may be able to add at an additional cost: dental or vision upgrades