What is Medicare Advantage (Part C)?

Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare that is offered by private insurance companies approved by Medicare. These plans provide all the benefits of Medicare Part A and Part B, and often include additional benefits such as prescription drug coverage, dental, vision, and hearing care.

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The Basics of Medicare Advantage

Medicare Advantage plans can offer more comprehensive coverage than Original Medicare, often at a lower cost.

Key benefits of Medicare Advantage:

Comprehensive Coverage: Most Medicare Advantage plans include additional benefits that are not offered by Original Medicare, such as prescription drugs, routine vision and dental care, and wellness programs.
Cost Efficiency: These plans often have lower out-of-pocket costs than Original Medicare. Some plans even offer $0 premiums or $0 deductibles.
One Plan Convenience: With Medicare Advantage, all your coverage needs are consolidated into one plan, making management of your health care simpler and more straightforward.

At River City Senior Benefits, our agents are experts in Medicare Advantage plans. We understand the importance of finding a plan that fits your medical needs and budget. Our team will help you compare different plans, explain the details of each option, and assist you in making an informed decision.

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Medicare Advantage Plans Typically Cover

Doctor & Specialists Visits

Hospital Stays

Preventative Care & Vaccines

Lab Work, X-Rays, Screenings

Outpatient Care & Procedures

Emergency Room Transport

What Is The Difference Between
Original Medicare and Medicare Advantage?

Choosing the right Medicare coverage involves understanding the options available and how they align with your healthcare needs and preferences. Two primary choices for Medicare coverage are Original Medicare and Medicare Advantage (Part C) plans. Each option offers different benefits and considerations regarding doctor and hospital choice, costs, coverage, and additional features like travel benefits. Below, we’ll explore the key differences between Original Medicare and Medicare Advantage plans to help you make an informed decision about your healthcare coverage.

Original Medicare

The Basics

Provided through the government

What’s Included in Medicare:

Part A
Medicare Part A helps pay for hospital stays and inpatient care
Part B
Medicare Part B helps pay for provider visits and outpatient care

While Medicare Parts A and B provide a crucial safety net, they DO NOT cover all healthcare costs. To address additional expenses, such as prescription drugs, dental, vision, and hearing care, you’ll need to get additional coverage.

Doctor & Hospital Choice

You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.

In most cases, you don’t need a referral
to use a specialist.

Cost

For Part B covered services, you first pay your deductible, then you pay 20% of the Medicare-approved amount. This is known as your coinsurance.
For Part B, you’ll have a payment each month called a premium. If you decide to get a Medicare drug plan (Part D), you’ll pay another premium for that.
There is no limit on what you pay out of pocket each year, unless you have supplemental coverage—like Medicare Supplement Insurance (Medigap).
You CAN choose to buy Medigap. Medigap helps pay your remaining out-of-pocket costs such as your 20% coinsurance. You can also use coverage from a current or former employer or union, or Medicaid.

Coverage

Original Medicare provides coverage for the majority of medically necessary services and supplies in hospitals, doctors’ offices, and other healthcare facilities.

However, Original Medicare DOES NOT include coverage for certain benefits such as eye exams, most dental care, and routine exams.
You can join a separate Medicare drug
plan to get Medicare drug coverage (Part D). This would be add-on coverage and an extra expense.
In most cases, you DO NOT need approval for Original Medicare to cover your services or supplies.

Foreign Travel

Typically, Original Medicare DOES NOT extend coverage for medical care outside of the United States.

However, you may be able to purchase a Medicare Supplement Insurance (Medigap) policy that provides coverage for emergency care while you’re abroad.

Medicare Advantage

The Basics

Offered by private companies

What’s Included in Medicare Advantage:

Part C

This is one policy that combines Part A (hospital insurance) and Part B (medical insurance).
Part D
Often include prescription drug coverage
Extra Benefits
Plans may offer some extra benefits that Original Medicare doesn’t cover – such as certain vision, hearing, and dental services.
.

Doctor & Hospital Choice

In most cases you can only use doctors and other provides within your plan’s network and service area for non-emergency care. Some plans offer non-emergency coverage out of network at a higher cost.

You may need a referral to use a specialist.

Cost

Out-of-pocket expenses differ depending on the plan, which might have lower or higher costs for specific services.
You pay the monthly Part B premium and may also pay the plan’s premium. Some plans have no premium and may even assist in covering all or part of your Part B premium. Additionally, most plans include Medicare drug coverage (Part D).
There is a limit on what you pay out of pocket each year for services that are covered by Part A and Part B. Once you hit your plan’s limit, you won’t have to pay anything for the services covered by Part A and Part B for the remainder of the year.
You CANNOT choose to buy Medigap.

Coverage

Medicare Advantage plans are required to provide coverage for all medically necessary services covered by Original Medicare.

Additionally, these plans may offer additional benefits not included in Original Medicare, such as certain vision, hearing, and dental services.
In most cases Medicare Advantage Plans include Medicare drug coverage (Part D). You generally can’t join a separate Medicare Dug plan.
In most cases, you DO need approval from your plan before it covers certain services or supplies.

Foreign Travel

Most plans DOES NOT include coverage for medical care outside the United States.

However, some plans may provide a supplemental benefit specifically for emergency and urgently needed services while traveling abroad.

Choosing the Right Medicare Advantage Plan

Selecting the right Medicare Advantage plan involves evaluating your healthcare needs, your budget, and the benefits each plan offers. Our agents are here to guide you through the selection process, ensuring you find a plan that best meets your requirements.

Medicare Advantage plans prioritize preventive checkups and managing chronic conditions, resulting in fewer hospital visits and lower medical expenses compared to traditional fee-for-service Medicare.

Let us assess which plan aligns best with your prescriptions and healthcare providers. We’ll also assist you in applying for any extra help you qualify for, all at no additional cost. Many of our clients were surprised to learn about these additional benefits!

Call us today for a free consultation and take the first step towards optimizing your healthcare coverage.

Who is Eligible for Medicare Advantage?

You are eligible for Medicare Advantage if you:

Are enrolled in Medicare Part A and Part B.
Live in the plan’s service area.
Are a U.S. citizen or lawfully present in the United States.

You are eligible even if you have a pre-existing condition.

It’s important to consider your existing coverage before joining a Medicare Advantage Plan. In some cases, joining a Medicare Advantage Plan might cause you to lose your employer or union coverage for yourself, your spouse, and your dependents, and you may not be able to get it back. However, in other cases, you may still be able to use your employer or union coverage along with the Medicare Advantage Plan you join. Your employer or union may also offer a Medicare Advantage retiree health plan that they sponsor. Be sure to understand the implications before making your decision.

When Can You Enroll for Medicare Advantage?

You can only join, switch, or drop a Medicare Advantage Plan during these enrollment periods:

Initial Enrollment Period

When you first become eligible for Medicare, you can join a Medicare Advantage Plan during your Initial Enrollment Period.

For most, this refers to a 7-month window that starts three months prior to turning 65.

Open Enrollment Period

The annual Election Period is between October 15 and December 7 each year. During this time:

Anyone with Medicare can join, switch, or drop a Medicare Advantage Plan.
Your coverage will begin on January 1 as long as the plan gets your request by December 7.

During your Initial Enrollment Period (IEP), there are specific rules regarding the timing of enrollment and coverage start dates:

Early Enrollment: If you sign up during the first 3 months of your Initial Enrollment Period, in most cases, your coverage starts the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month.
Enrollment at Age 65: If you join a Medicare Advantage Plan the month you turn 65, your coverage will start the first day of the following month.
Late Enrollment: If you sign up during the last 3 months of your Initial Enrollment Period, your coverage will start the first day of the month after you sign up.

Additionally, if you join a Medicare Advantage Plan during your Initial Enrollment Period, you have the flexibility to change to another Medicare Advantage Plan or return to Original Medicare within the first 3 months you have Medicare.

Medicare Advantage Open Enrollment Period

Between January 1 and March 31 of each year, you can make ONE of these changes:

If you’re in a Medicare Advantage Plan you can switch to another Medicare Advantage Plan.
You can drop your Medicare Advantage Plan and return to Original Medicare. You can also join a separate Medicare drug plan (Part D). (You’ll be disenrolled from Medicare Advantage automatically.)

Changes take effect the first of the month following your request.

Please Note: If you have Original Medicare you CANNOT switch to a Medicare Advantage Plan, join a Medicare drug plan, or switch from one Medicare drug plan to another.

Special Enrollment Period

In most cases, once you join a Medicare Advantage Plan, you’re committed for the calendar year from the start of your coverage. However, certain situations may qualify you for a Special Enrollment Period. During this time, you can join, switch, or drop a Medicare Advantage Plan.

Qualifying Situations for a Special Enrollment Period may include:

Changing your residence to an area outside of your plan’s service area.
Losing your current coverage, such as employer-sponsored insurance or Medicaid
Gaining eligibility for other coverage, such as through Medicaid or a new job.
Your plan changing its contract with Medicare
SEP for Low Income Subsidy
Medicare Savings Program (the state pays your Part B)
Other special situations.

We are also happy to help you qualify and enroll in these programs. Give us a call today!

Under 65 Disability Enrollment

If you’re under 65 and have a disability, you’ll automatically receive Part A and Part B after receiving disability benefits from Social Security or certain disability benefits from the Railroad Retirement Board for 24 months.

Additional Medicare Programs You May Qualify For

SEP for Low Income Subsidy (LIS)

The Low Income Subsidy, also known as Extra Help, is a program that helps individuals with limited income and resources pay for Medicare prescription drug plan costs, such as premiums, deductibles, and copayments.

Medicare Savings Program (MSP)

The Medicare Savings Program is a state-administered program that helps pay for Medicare Part B premiums and may also cover other Medicare costs (such as deductibles and copayments) for individuals with limited income and resources.

To see if you qualify for these programs and get help with the application process, please reach out to us. We are here to make the process as smooth as possible and ensure you receive the benefits you’re entitled to.

Feel free to contact us at 1-888-270-0054, or click the button below and fill out our easy online form to speak with an agent.

Protect Yourself From Unexpected Out-of-Pocket Expenses

Advantage Plus Hospital Confinement Indemnity Insurance helps fill gaps in coverage after a hospitalization event, covering Medicare Advantage copays, deductibles, ambulance trips, outpatient surgery, and more. It’s flexible, affordable, and pays policyholders directly based on their time spent in the hospital.

Now is the time to consider Advantage Plus for added peace of mind. Contact Riverside City Senior Benefits today for more information.

Questions and Answers About Medicare Advantage

How do I apply for Medicare Advantage?

To apply for Medicare Advantage, you must first be enrolled in Medicare Part A and Part B. Once eligible, you can enroll in a Medicare Advantage plan during specific enrollment periods. You can view more information on enrollment periods here. Give us a call today and we’ll help walk you through the process and answers all of your questions.

What are the differences between Medicare Advantage and Original Medicare?

Original Medicare provides coverage for hospital care (Part A) and medical services (Part B) on a fee-for-service basis. Medicare Advantage plans offer the same coverage as Original Medicare, but generally also include additional benefits such as prescription drug coverage, dental, vision, and hearing services. For a full breakdown of the differences between original Medicare and Medicare Advantage click here.

Are there different types of Medicare Advantage plans to choose from?

Yes, there are several types of Medicare Advantage plans, including Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medical Savings Account (MSA) plans. Each type of plan has different rules and coverage options. Give us a call and we can help you get the right one for you!

How do I switch from Original Medicare to a Medicare Advantage Plan?

You can switch from Original Medicare to a Medicare Advantage plan during specific enrollment periods, such as the Annual Enrollment Period (October 15 to December 7) or the Medicare Advantage Open Enrollment Period (January 1 to March 31). Simply give us a call and we’ll help you determine the right plan for you. We can answer all your questions so you feel confident in your medical coverage.

What should I look for when choosing a Medicare Advantage plan?

When choosing a Medicare Advantage plan, consider factors such as the plan’s network of providers, coverage for prescription drugs and other benefits, out-of-pocket costs including premiums, copayments, and deductibles, as well as the plan’s star ratings and customer satisfaction scores.

Can I go back to Original Medicare from a Medicare Advantage Plan?

Yes, you have the option to switch from a Medicare Advantage plan back to Original Medicare during certain enrollment periods. The Annual Enrollment Period (October 15 to December 7) and the Medicare Advantage Open Enrollment Period (January 1 to March 31) allow you to make changes to your Medicare coverage. We would be more than happy to inform you of your options. Just give us a call today!

Can I enroll in a Medicare Advantage plan if I have pre-existing health conditions?

Yes, individuals with pre-existing health conditions are generally eligible to enroll in Medicare Advantage plans during specific enrollment periods, such as the Initial Enrollment Period, Annual Enrollment Period, or Special Enrollment Periods. Medicare Advantage plans cannot deny coverage based on pre-existing conditions. However, it’s essential to review plan options carefully to ensure they meet your healthcare needs and budget. Contact us today and we’ll help you navigate your options and find the right plan for you.

How do Medicare Advantage plans handle emergency care and urgent care services?

Medicare Advantage plans typically cover emergency care and urgent care services, both in and out of network, at the same level as Original Medicare. However, it’s important to review the plan’s coverage details to understand any specific requirements or costs associated with accessing emergency or urgent care services.

More Questions? For answers to all your questions, please schedule a consultation with one of our agents. We’re here to help you navigate your Medicare Advantage options and secure the coverage you need for a healthier future.