Medicare Advantage

A Different Approach to Medicare: The Benefits of a Medicare Advantage Plan (Part C)

While Original Medicare (Parts A & B) provides a solid foundation, many people find they need more comprehensive coverage and a more predictable budget for their healthcare costs. This is where Medicare Advantage, also known as Part C, comes into play. At Rhonda Fisher Insurance, we help our clients understand how these private plans can offer an alternative way to receive their Medicare benefits.

What is a Medicare Advantage Plan?

A Medicare Advantage Plan is a type of Medicare-approved health plan from a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. These “bundled” plans often include additional benefits that Original Medicare does not cover. Think of it as a one-stop-shop for your healthcare needs. Instead of paying for a Part A and Part B premium and then potentially needing to purchase a separate drug plan and a Medigap plan, a Medicare Advantage plan can combine all of these coverages into one single plan.

Key Features and Benefits of Part C:

• All-in-One Coverage: Every Medicare Advantage plan must, by law, cover everything that Original Medicare (Parts A and B) covers. However, most plans go above and beyond, offering a host of extra benefits that can significantly enhance your coverage.
• Extra Benefits You’ll Love: Many of our clients are drawn to Medicare Advantage plans because of the supplemental benefits. These can include:
  • Prescription Drug Coverage: The vast majority of Medicare Advantage plans (known as MA-PDs) include built-in Part D prescription drug coverage. This eliminates the need for a separate drug plan and simplifies your coverage.
  • Routine Vision, Dental, and Hearing Care: Unlike Original Medicare, many Part C plans offer coverage for routine dental cleanings, vision exams, and hearing aids. These are crucial services that can improve your quality of life.
  • Wellness and Fitness Programs: A growing number of plans include gym memberships or fitness program benefits, encouraging you to stay active and healthy.
  • Other Unique Benefits: Depending on the plan, you might find coverage for things like transportation to doctor’s appointments, over-the-counter (OTC) allowances for health items, and even meal delivery services after a hospital stay.

How Do Costs and Networks Work?

Medicare Advantage plans operate with their own cost-sharing structures, which can be different from Original Medicare. Instead of the 20% coinsurance for Part B services, you might have set copayments for doctor visits, specialists, and hospital stays. One of the most significant advantages is the annual out-of-pocket maximum. Once you reach this limit, the plan pays 100% of your covered Part A and Part B services for the rest of the year. This provides invaluable financial predictability that Original Medicare lacks.

It’s important to be aware of how Medicare Advantage plans use provider networks. Most plans are either Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs):

• HMOs: These plans typically require you to choose a primary care physician (PCP) within the plan’s network and get a referral to see a specialist. Your care is generally limited to the plan’s network of doctors and hospitals, except in emergencies.
• PPOs: These plans offer more flexibility. You don’t need a referral to see a specialist and you can see out-of-network providers, though you will likely pay a higher cost-sharing amount.

Choosing the right type of plan is essential, and at Rhonda Fisher Insurance, we’ll help you review your current doctors and preferred hospitals to ensure they are in-network with the plans you are considering.

Is Part C Right for You?

Medicare Advantage plans offer an appealing combination of comprehensive coverage, predictable costs, and valuable extra benefits. However, they aren’t the right fit for everyone. The choice between a Medicare Advantage Plan and Original Medicare with a supplement is a personal one. It depends on your health needs, financial situation, and how you prefer to receive care. Rhonda Fisher is an expert at helping you weigh these options, comparing plans from multiple carriers to find the one that best fits your lifestyle. Let’s schedule a time to talk about your unique situation and see if a Part C plan is the right solution for you.