An Advantage Plan from your state-issued health plan is often referred to as Medicare Part C or MA Plans. These plans are offered to consumers by private state-approved healthcare companies.
If you decide to become part of an Advantage Plan, you’ll receive Part A and B coverage along with Part C benefits. Part A entails hospital insurance and Part B is your medical insurance. A Part C plan may provide you with additional benefits such as dental, hearing, and vision. You may also want to include Part D which will cover the cost of your prescription medications.
State-issued insurance covers a certain amount of your healthcare each month to the companies that provide Advantage Plans. These companies must adhere to Medicare-approved rules and each Advantage Plan will charge a different amount or have various rules for how you can receive services, such as whether you need to get a referral to see a specialist or if you can only go to suppliers or facilities that are part of your plan to receive non-urgent care. Make sure you receive an update on your health insurance rules often since they can change yearly.
Part C plans are considered an “all-in-one” alternative to original state-issued health insurance. This means you’ll still have state-sponsored even if you have a Part C plan.
Covered Part C Services
Most Advantage Plans will offer coverage for things your original state-issued health plan doesn’t cover, including some hearing, vision, dental, and fitness programs such as gym discounts or memberships. You can also find plans that will offer transportation for you to get to and from doctor visits and discounts for over-the-counter medications to help you maintain or improve your health. Some healthcare plans offer a customized benefits package for enrollees who suffer from chronic illnesses or need treatment for specific health conditions. It’s best to check all the terms of your Advantage Plan before enrolling to make sure you’re aware of the benefits and to see if there are any stipulations that would prevent you from being qualified.
Part C Plan Rules
State-issued health insurance pays a fixed amount of your medical care monthly to the private companies that offer Advantage Plans. These companies have to follow state-sponsored health insurance rules and standards. Keep in mind that every Advantage Plan can charge different amounts it comes to what you’ll pay out of pocket and have different rules for how you can receive services, such as whether you require a referral to visit a specialist and whether you have to visit in-network doctors to receive non-emergency care.
How Much You’ll Pay for Advantage Plans
What you’ll pay for a Part C plan depends on a few factors. In some situations, you’ll have to use providers and physicians within your plan’s network to get the best deals on healthcare. Some Advantage Plans won’t pay for services you receive from providers who are outside of your service area or network.
Prescription Drug Coverage
Most Part C plans come with Part D, which is prescription drug covers. You can join a state-issued Prescription Drug Plan with certain health insurance plans that can’t offer prescription coverage such as Medical Savings Account Plans. If you decide to join a separate prescription drug plan or you’re in an Advantage HMO or PPO plan, you’ll automatically be unenrolled from the Advantage Plan to go back to your original state-issued health insurance plan. You can learn more about Medicare on www.clearmatchmedicare.com.
Medigap and Advantage Plans
Advantage Plans and Medigap can not work simultaneously. If you have a Medigap policy and join a Part C plan, it may be best to drop the Medigap policy since Medigap won’t pay for premiums, deductibles, and copayments.
If you decide to cancel Medigap, get in touch with your insurance company. If you leave your Part C plan, you may not be able to the same Medigap policy back. Get in touch with your state insurance department if you’re not switching back to your original state-sponsored policy and a company tries to sell you a Medigap policy since this is illegal. If you prefer to go back to your original state plan and purchase a Medigap policy, talk to an Advantage Plan professional to see if you can unenroll.
Joining Part C For the First Time
If you join an Advantage Plan for the first time and you’re not satisfied with the plan, you’ll have specific rights according to federal law to purchase a Medigap policy. You can retain these federal rights if you go back to your original state-issued insurance within a year of joining the plan.
If you already had Medigap before joining the Advantage Plan, you could receive the same policy if the company still offers it. If it is no longer available, you can purchase another Medigap policy. However, Medigap can not overcover prescription drugs even if you had this advantage previously, but you may be able to join a Part D plan. Some states also offer special rights if you joined an Advantage Plan when you were initially eligible for your state-sponsored plan.
Keep these important factors in mind when you’re searching for a Medicare policy that will best take care of your medical needs.
