Medicare Advantage

Medicare Part C

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Medicare Advantage - Medicare Part C

Medicare Advantage plans (Medicare Part C) are a form of private health insurance that provide the same coverage as Original Medicare Part A and Part B and may include additional benefits such as dental, vision and prescription drug coverage.

Benefits of Medicare Advantage

Medicare Advantage plans (Medicare Part C) are an alternative way to get Medicare coverage through private insurance companies instead of the Federal government.
They provide the same benefits as Original Medicare and may include additional benefits such as:

Dental Care

Dental Care

Prescription Drugs

Prescription Drugs

Vision Care

Vision Care

Health Consultation

Health Consultation

Hearing Aids and Hearing Exams

Hearing Aids and Hearing Exams

Fitness and Wellness

Fitness and Wellness

As of 2020, more than 22 million people are enrolled in Medicare Advantage plans

(Source: Kaiser Family Foundation (KFF))

Medicare Advantage - Medicare Part C FAQs

All Medicare Advantage plans include the same standard benefits as Original Medicare. Most Medicare Advantage plans also provide prescription drug coverage. Some Part C plans may also cover benefits such as:
  • Routine dental and vision care
  • Hearing care and allowances for hearing aids
  • Health and wellness club memberships, such as Silver Sneakers, Silver and Fit or Optum Fit.
  • Some Medicare Advantage plans may also cover services such as non-emergency medical transportation, home health care and home modifications such as bathroom grab bars.
  • over-the-counter (OTC)
Some types of plans restrict your coverage to in-network health care providers.
The Centers for Medicare & Medicaid Services (CMS) released the 2022 premiums, deductibles and other key information for Medicare Advantage and Part D prescription drug plans in advance of the annual Medicare Open Enrollment to help Medicare enrollees decide on coverage that fits their needs. The average premium for Medicare Advantage plans will be lower in 2022 at $19 per month, compared to $21.22 in 2021, while projected enrollment continues to increase. As previously announced, the average 2022 premium for Part D coverage will be $33 per month, compared to $31.47 in 2021.

Open Enrollment is the one time each year when more than 63 million people with Medicare can review their health care coverage to find new plans or change existing plans, discover extra benefits and help them save money.”

An increasing number of Medicare Advantage dual eligible special needs plans cover both Medicare and Medicaid services for people who are dually eligible. In 2022, 295 plans (compared to 256 in 2021), will cover all Medicare services, plus Medicaid-covered behavioral health treatment or long-term services and supports, through a single organization.

CMS will continue to test the Part D Senior Savings Model in more than 2,100 plans in 2022, increasing access and affordability to select insulins for seniors. Over 500 new Medicare Advantage and Part D prescription drug plans, and two new pharmaceutical manufacturers of insulin, are joining the model this year to provide even more opportunities for eligible seniors to reduce their out-of-pocket spending on insulin.
To be eligible to sign up for a Medicare Advantage Plan, you must be signed up for Medicare Part A and Enrolled In Medicare Part B.

There are 3 general eligibility requirements to qualify for Medicare Part C: You must be enrolled in Original Medicare (Part A and Part B) There must be a Medicare Advantage plan offered in your area You do not have End Stage Renal Disease (ESRD) however effective January 1, 2021 person with ESRD may enroll in Medicare Advantage Plans.

You enroll in a Medicare Advantage plan through a private insurance company, not the government.

You must be enrolled in Original Medicare (Parts a and B) before you can enroll in a Medicare Advantage plan. You cannot have a Medicare Advantage plan and a Medicare Supplement insurance policy at the same time.

If your Medicare Advantage plan does not include prescription drug coverage, you may be allowed to add a Medicare Part D plan as well.
Enrollment period Dates Actions you can take during this period Initial Enrollment Period Starts 3 months before the month you turn 65 Ends 3 months after the month you turn 65 – Sign up for a plan Medicare Open Enrollment Period (aka Annual Enrollment)

Starts October 15th
Ends December 7th – Sign up for a plan

– Switch plans – Leave a plan Special Enrollment Period Depends on your personal situation (such as if you move or lose your – -insurance coverage) Depends on your personal situation (such as if you move or lose your insurance coverage) General Enrollment Period Starts January 1st Ends March 31st Sign up for Medicare Part A and/or Part B (only if you didn’t sign up when first eligible and if you’re not eligible for a Special Enrollment Period)

Medicare Advantage Open Enrollment Period Starts January 1st Ends March 31st – Switch Medicare Advantage plans Medicare requires that you enroll, dis-enroll, or make changes to your Medicare Advantage plan only during pre-determined enrollment periods. if you are enrolling for the first time, you may be able to join a plan during your Initial Enrollment Period, which occurs around your 65th birthday, or around your 24th month of disability (if you’re under 65 and eligible for Medicare).

You also may be able to join or switch plans during the Annual Election Period (AEP, also commonly called the Fall Medicare Open Enrollment Period for Medicare Advantage plans), which runs from October 15 to December 7 every year.

There are also Special Enrollment Periods (SEPs) that may allow you join a plan outside of the main enrollment periods, depending on your circumstances. Qualifying circumstances for a Medicare Special Enrollment Period include, but aren’t limited to:

  • Moving outside of your current plan’s coverage area
  • Moving to an area where additional coverage options exist
  • Losing employer coverage
  • Moving into or out of a skilled nursing facility
  • Qualifying or dis-qualifying for Medicaid
  • Qualifying the State Pharmaceutical Assistance Plan
  • National State of Emergency and More
The number of Medicare Advantage plans available to you will depend in part on where you live and how many companies offer coverage in your area.

There are 5 major types of Medicare Advantage plans:

1. Health Maintenance Organizations (HMOs)

These plans feature a network of participating health care providers.
With a Medicare HMO, you typically select a primary care physician (PCP). Your PCP coordinates your care and makes referrals to specialists within your plan network when you need additional care.

Your coverage is generally limited to only the providers within the HMO plan network.

2. Preferred Provider Organizations (PPOs)

A Medicare PPO plan typically features a network of providers.

Unlike an HMO plan, a PPO plan may allow you to receive covered services from providers outside of the plan network, though you may pay higher out-of-pocket costs when you go outside of the network.

PPO plans typically do not require you to have a primary care physician, and you typically aren’t required to get a referral to see a specialist.

3. Private Fee-for-Service (PFFS) plans


A PFFS plan may not feature a network of preferred providers. You can typically visit any health care provider who accepts Medicare and the terms and conditions of your plan.

4. Special Needs Plans (SNPs)


A Special Needs Plan is a certain type of Part C plan that is designed for people with a specific health condition or those who are dual-eligible for Medicare and Medicaid.

5. Medical Savings Accounts (MSAs)

A Medical Savings Account combines a high-deductible health plan with a savings account. The plan distributes money into the savings account, which you may then use to pay for qualified medical expenses. The type of plan you choose may affect your prescription drug coverage options, referral requirements and network restrictions.
You should review the following 4 factors before enrolling in a specific Medicare Advantage plan:

  1. Type of plan
  2. Benefits
  3. Star rating
  4. Costs

A licensed insurance agent can help you compare the above information for the Medicare Advantage plans that are available where you live.

Additionally, as a best practice, verify that your medical doctors are “in-network” and your prescription drugs are listed in the plans formulary.
A Medicare Advantage plan allows you to bundle your Medicare Part A and Part B benefits into a single plan.

If want coverage for prescription drugs, dental benefits, routine vision care and other benefits that aren’t covered by Original Medicare, you may want to consider a Medicare Advantage plan that offers those benefits.

Medicare Advantage plans also include an annual out-of-pocket spending limit, which Original Medicare doesn’t cover. Out-of-pocket Medicare costs can add up quickly, and an out-of-pocket spending limit could potentially help you save money.

Speak with a licensed insurance agent to learn more about whether a Medicare Advantage plan may be right for you.

Interested in Medicare Advantage?

Speak with a licensed insurance agent to learn more about whether a Medicare Advantage plan may be right for you

Other Medicare Plan options

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