Medicare is health insurance that is provided by the U.S. government to citizens or individuals who have worked at least 10 years (40 quarters) in a Medicare-sponsored job. This health insurance is broken down into different types of services. In order to be eligible for Medicare an individual also has to be at least age 65 or older. Younger individuals can become eligible for Medicare if they have End-Stage Renal Disease.
Medicare is broken up into four parts: A, B, C, and D. Medicare Part A is considered your hospital insurance. It covers your hospital stay in an inpatient facility, skilled nursing care, hospice, and some home health care services. There is a deductible that needs to be met before your Part A covers your expenses. Similarly, Part B, which covers your medical care outside of a hospital, also has a deductible as well as copayments that you may need to make. Your Part B will cover care such as regular check-ups, lab tests, and outpatient services.
What Is Medicare Part C (Medicare Advantage)?
Medicare Part C, commonly known as Medicare Advantage, is an alternative way to receive your Medicare benefits. Rather than getting coverage directly through the federal government (Original Medicare), Medicare Advantage plans are offered by private insurance companies that are approved by Medicare. These plans bundle your Part A (hospital insurance) and Part B (medical insurance) coverage into a single plan. Most Medicare Advantage plans also include Part D prescription drug coverage, and many offer additional benefits that Original Medicare does not cover, such as dental, vision, hearing, and wellness programs.
Medicare Advantage plans were established by the Balanced Budget Act of 1997. With a Medicare Advantage plan, the federal government pays the private insurance company a fixed amount per member to manage your care. You will typically use a network of doctors, hospitals, and other healthcare providers, depending on whether you choose an HMO, PPO, or other plan type.
It is important to understand that Medicare Advantage is not the same as Medigap (Medicare Supplement). Medigap plans supplement Original Medicare by helping pay for out-of-pocket costs like copayments, coinsurance, and deductibles. Medicare Advantage, on the other hand, replaces Original Medicare entirely and delivers your Part A and Part B benefits through a private insurer.
Which Medicare Advantage Plan Should I Choose?
Medicare Advantage plans come in several types, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, and Special Needs Plans (SNPs). Each plan type has different rules about how you receive care, which providers you can see, and what your costs will be. The best way to know which plan will work for you is to speak to one of our representatives at South Florida Medicare Specialists. You want to ensure that your plan includes your doctors, covers your medications, and fits your healthcare needs and budget.
Am I Eligible for a Medicare Advantage Plan?
To enroll in a Medicare Advantage plan, you must be enrolled in both Medicare Part A and Part B, and you must live in the plan’s service area. You generally cannot enroll if you have End-Stage Renal Disease, although recent changes have expanded eligibility in some cases.
You can enroll in a Medicare Advantage plan during your Initial Enrollment Period when you first become eligible for Medicare, during the Annual Election Period (October 15 through December 7 each year), or during the Medicare Advantage Open Enrollment Period (January 1 through March 31). If you have questions about when you can enroll, give us a call so we can discuss your situation in detail.
Medicare Advantage plans must cover all of the services that Original Medicare covers. Additionally, your plan cannot drop you for health reasons as long as you continue to pay your premiums and live in the plan’s service area. Many Medicare Advantage plans also have an annual out-of-pocket maximum, which gives you the peace of mind of knowing your costs are capped even if you have a particularly difficult health year. To learn more about Medicare Advantage plans in your area, contact the South Florida Medicare Specialists today.