Affordable Medicare Advantage Plan
(Medicare Part C)

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Medicare Advantage Plan (Part C)

As part of Medicare, you may have the option of enrolling in a Medicare Advantage also known as Part C Coverage. These plans, also known as ‘MA/MAPD Plans’, or ‘All-In-One Plans’ are provided by Medicare-approved Insurance Carriers. Premiums are set at a fixed rate regardless of age and some plans even being premium-free. Learn what Medicare Part C coverage has to offer.

  • If you enroll in a Medicare Advantage Plan, you must continue to pay your Medicare Part B premium, as well as any plan-specific premiums (if any).
  • A Medicare Supplement Insurance Plan and a Medicare Advantage Plan cannot be purchased at the same time.

Most also include the following along with the Medicare Part A and B Coverage:

  • Vision, hearing, dental, and/or health and wellness programs are examples of optional coverage (these benefits are not offered in Original Medicare)
  • Drug Coverage (Part D) is included in most plans
  • Plans may have lower co-pays/coinsurance costs than Original Medicare.

These services are subject to a variety of copays, coinsurance, and deductibles, depending on the plan.

Different Types of MAPD Plans:

HMO – Health Maintenance Organization:

Except in an emergency, most HMOs only allow you to see doctors, specialists, or hospitals on the plan’s list/network. Prior to seeing a specialist, you need to obtain a referral from your primary care physician.

HMO-POS is an acronym for HMO Point of Service Plan.

This is an HMO plan that lets you to pay a higher price for out-of-network treatments.

PPO – Preferred Provider Organization:

If you utilize physicians, hospitals, and other health care providers who are part of the Medicare Advantage plan’s network, you will pay less in most PPOs. You can also see physicians, hospitals, and providers out-of-network, but you’ll have to pay higher copays and coinsurance.

PFFS – Private Fee for Service:

Like Original Medicare, PFFS plans allow you to see any doctor, other health care professional, or hospital if they agree to treat you. The Medicare Advantage Plan sets how much the government will pay doctors, other health-care providers, and hospitals, as well as how much you will have to pay when you receive care.

SNP – Special Needs Plan:

SNPs provide targeted and specialized health care to certain groups of individuals, such as those with Medicare and Medicaid, those who reside in nursing homes, and those who have certain chronic medical problems.

MSA – Medical Savings Account:

This is a health-insurance plan with a high deductible that also includes a bank account. Money is deposited into the account by Medicare (usually less than the deductible). You can use the funds to cover the cost of your health-care services throughout the year.

Definitions:

Copay

A fixed amount for a covered service (e.g. $10 or $20) you pay to an insurance provider

Coinsurance

The percentage of costs of a covered health care service (e.g. 10%, 20%) you pay after you've paid your deductibler

Deductible

The amount you pay out of pocket before your plan will pay any expenses

Out-of-Pocket Maximum

Maximum limit you'll spend out of pocket in a given calendar year

Out-of-Pocket

Amount you pay out of your own pocket for health services

Formulary

A list of generic and brand name prescription drugs covered by your health plan