Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These “Bundled” plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare prescription drug (Part D).
To enroll in a Part C plan, you must be enrolled in both Parts A and B.
You must live in the plan service area.
The most important element of Medicare Advantage or Part C is that it is not Original Medicare. It is an alternative to Original Medicare and is managed by private insurers. This means that once you enroll, your Medicare coverage will come from the Advantage plan itself, and no longer from the government.
There are 2 ways to get medicare:
- Original Medicare (Government) 80% + Medicare Supplement (Private) 20% + Prescription Drug Plan (Private)
- Medicare Advantage (some includes Prescription Durg Plan, Dental, Vision, Hearing and Wellness Benefits)
This is a choice whether you wish to join a Medicare Advantage Plan or just stay with your original Medicare A & B and enrolling in Medigap / Medicare Supplement Plan. Call us and we can help you determine the best path that will work for you.
Who provides coverage?
Private insurance companies approved by Medicare like UnitedHealthCare, Humana, Anthem, Aetna, etc.
How come I do not enroll in it at Social Security like A & B?
Because Part C is voluntary. Some people prefer to get their Medicare coverage from Original Medicare and traditional Medicare Supplement plans. Others do not mind being in a network and like having just one plan that includes all of the services provided by Original Medicare, Prescription Drug Plan, Dental, Vision and other Wellness benefits all wrapped into one plan with one monthly premium.
How do you choose your providers?
We can help you determine the best plans in your area and personalize it to your needs. You choose the one the works best for you.
How much does it cost?
- You usually pay a low and sometimes no monthly premium for your MA Plan (in addition to your monthly Part B premium).
- You may pay a co-payment or coinsurance for covered services. Many MA plans offer vision, hearing, and dental coverage. Costs, extra coverage, and rules vary by plan.
- Plans have a yearly limit on your out-of-pocket costs. Once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year.
- Your out-of-pocket costs may be lower in an MA plan.
Medicare Advantage Plans cover all Medicare services
Medicare Advantage Plans must cover all of the services that Original Medicare covers. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgently needed care.
The plan can choose not to cover the costs of services that aren’t medically necessary under Medicare. If you’re not sure whether a service is covered, check with your provider before you get the service.
Most Medicare Advantage Plans offer coverage for things that aren’t covered by Original Medicare, like vision, hearing, dental, and wellness programs (like gym memberships). Plans can also cover more extra benefits including services like transportation to doctor visits, over-the-counter drugs, adult day-care services, meal plans, and other health-related services that promote your health and wellness.
Plans can also tailor their benefit packages to offer these new benefits to certain chronically ill enrollees. These packages will provide benefits customized to treat those conditions. Check in with us to see what benefits are offered on every plan available in Nevada.
Most include Medicare prescription drug coverage (Part D).
Drug coverage in Medicare Advantage Plans
Most Medicare Advantage Plans include prescription drug coverage (Part D).
You may be able to join a stand-alone prescription drug plan if you enroll in a plan that does have prescription drug plan:
- Can’t offer drug coverage (like Medicare Medical Savings Account plans)
- Choose not to offer drug coverage (like some Private Fee-for-Service plans)
You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these occur:
- You move out of the plan’s service area.
- You join a separate Medicare Prescription Drug Plan.