Medicare Advantage, offered by private insurance companies and approved by Medicare, provides health insurance coverage after you turn 65, but it’s different from regular Medicare.
Medicare Advantage Pros:
- The plan covers everything traditional Medicare covers (hospital insurance and medical insurance) as well as emergency and urgent care
- Many plans also cover dental care, eyeglasses, and wellness programs
- Most plans also include prescription drug coverage
- It’s convenient to have a single plan for everything
- Your eligibility isn’t affected by health or financial status
- Premiums are low
Medicare Advantage Cons:
- Plan benefits can change from year to year
- Plan premiums can change from year to year
- You’re restricted to certain doctors in your network (unless it’s an emergency)
- You’re subject to high deductibles and co-pays that tend to range from $3,000-$7,550
- Difficult to switch to Medigap later on
6 Medicare Advantage Plans:
Let’s compare the 6 Medicare Advantage plans:
- Health Maintenance Organization (HMO) plans: In most HMOs, you can only go to doctors in your network (except in an urgent or emergency situation).
- Preferred Provider Organization (PPO) plans: In a PPO, you pay less if you use doctors in your network. You usually pay more if you go outside of your network.
- Private Fee-for-Service (PFFS) plans: PFFS plans are similar to Original Medicare in that you can generally go to any doctor as long as they accept the plan’s payment terms. The plan determines how much it will pay and how much you must pay when you get care.
- Special Needs Plans (SNPs): SNPs provide specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.
- HMO Point-of-Service (HMOPOS) plans: HMO plans may allow you to get some services out-of-network for a higher copayment or coinsurance.
- Medical Savings Account (MSA) plans: These plans combine a high-deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. MSA plans don’t offer Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan.
Medicare Advantage/Part C FAQs
Do you generally recommend choosing the Medicare Part C plan?
Medicare Advantage is usually a great fit for veterans and individuals who are dual eligible (eligible for both Medicare and Medicaid). Medicare Advantage can also be a good option for everyday consumers who prefer to have a higher deductible in exchange for lower premiums. Individuals who rarely see the doctor and don’t see that changing, are challenged financially, and/or would rather have low premiums in exchange for some risk are great candidates for a Medicare Advantage plan. In general, we find that a Medicare Supplement is a better fit for most clients, but there are certainly exceptions.
How much does Medicare Part C cost?
You must pay the Part B premium and the Part C premium. The Part B premium is standardized and tends to raise a little bit each year ($170.10 as of 2022). The Part C premium varies among plans, but is generally inexpensive with the majority of plans offering $0 premiums. Don’t forget about co-pays and deductibles as well as the out-of-pocket maximum which can typically range from $3,000-$7,550.
Who is eligible for Medicare Part C?
You must be enrolled in Medicare Part A and B to be eligible for Medicare Advantage. You also must live in your plan’s network to be eligible. Those with End-Stage Renal Disease aren’t accepted into a Medicare Advantage plan.
Are Medicare Part C plans standardized by the government?
No, they aren’t. This is what causes the big differences between plans. You’ll see varying amounts of coverage, deductibles, co-pays, and so on. These can also change each year.