Medicare Advantage or Medicare Part C

Medicare Advantage plans, also known as Medicare Part C, are another way to get the same coverage that is available through Medicare Part A and Part B. The main difference is that Medicare Advantage plans are provided through a private health insurance company rather than through the federal government. These plans can be either HMO or PPO type plans and are required to provide the same coverage as offered through Original Medicare. Additionally Medicare Advantage plans are able to provide extra benefits that are not usually available through Original Medicare things like : gym memberships, transportation, dental and vision benefits.

One of the additional benefits offered by Medicare Part C plans is prescription drug coverage or Medicare Part D benefits. Oftentimes these drug benefits are automatically included in Medicare Advantage plans at no additional cost. This is one of the advantages of getting a Part C plan because you may not have to purchase a separate stand alone Prescription Drug plan (PDP). Having all your Medicare Part A, Part B and Part D benefits run through a single entity like a private health insurance company can streamline the process and make utilizing all these services easier. If you enroll into a Medicare Advantage plan that includes prescription drug coverage, then you will not be able to enroll in a stand alone Part D plan as well. You will have to use the drug coverage that is offered through your Medicare Advantage plan.

Costs for services under a Medicare Advantage plan can vary from one plan to another and will change based on the company and area you live in.

Different types of Medicare Advantage plans

There are many different types of Medicare Advantage plans, not every type is available in every area or by every insurance provider. It is important to check which ones are available in your area before you apply.

• Health Maintenance Organization (HMO) Plan: This type of plan has a specific group of doctors and hospitals that enrollees are able to use for healthcare services. This means that the doctors and hospital networks you can use are more limited than other types of Medicare Advantage plans. Furthermore if you use a doctor who is not within the HMO network the insurance plan will not cover the services that you received, and you will normally need to get a referral from your primary care doctor to go see a specialist or get other services performed.
• Preferred Provider Organization (PPO): These types of Medicare advantage plans offer doctors that are both in network and out of network. This gives beneficiaries the option to see doctors who are directly contracted with the health insurance company or not. The doctors and hospital networks are less restrictive than the HMO style plans. But if a person uses doctors who are not “in network” they will usually pay a higher out of pocket cost than if they see a doctor who is in the network.
•  Special Needs Plans (SNPs): These types of plans are specifically for people with certain illnesses, qualify for extra help via a low-income program or are institutionalized. In order to apply for one of these programs you must fall within one of the categories of people who they are designed to help. These illnesses can be heart conditions, lung conditions, diabetes or if somebody is eligible for a Medicaid or Medi-Cal program for low income individuals.

Who is eligible for Medicare Advantage Plans?

To be eligible for a Medicare Advantage plan or Medicare Part C , you must first currently be enrolled into a Medicare Part A and B plan. Also you must live within the plan service area where you are applying.

For people applying for a special needs plan you must be in one of the subcategories that each of the plans is designed to assist and generally qualify for a Special Enrollment Period (SEP) that allows you to enroll throughout the year.

If you are not eligible for a Special Needs Plan you may be able to enroll during the Annual Election period which occurs October 15th through December 7th annually.

Finally for people who are currently enrolled in an employer plan or a union sponsored health insurance, if you enroll into a Medicare Advantage plan it may force you to cancel your other plan. In some cases, you will not be able to return to your employer or union sponsored plan. It is important you check with your employer or union about the specifics of your work insurance before you enroll into a Medicare Advantage plan on the individual market.

We are the Covered California Enrollment Center, your place to get free assistance with your health insurance plan. We can assist you to sign up, enroll and update your private health Insurance, Covered California plan, Medi-Cal, Obamacare and Medicare insurances. Our California agency is certified by Covered California, to assist you in-person, over the phone or online in English and Spanish. 

We specialize in individual and family health insurance plans, Medicare, Medicare Advantage plans, Medicare Supplement (MediGap plans), Medicare Prescription Drug plans (Part D), as well as, Dental and Vision coverage. We can help you get enrolled into health insurance plans, compare healthcare options, provide required health coverage tax documents and review the plans that best fit your budget and healthcare needs.  

Call us today at 844-367-6555 for free assistance over the phone, visit our website at www.EnrollSocal.Com to make an appointment at our California Enrollment Centers Serving San Diego County, Los Angeles County and Imperial County.