The Medicare Alphabet: Part C {Medicare Advantage} – The most complicated of all!

Medicare Advantage

Now, from recent blogs, you know about the benefits and costs of Medicare Part A, Medicare Part B and Medicare D. So, here is Medicare Part C. C stands for complicated! There are many decisions you have to weigh when you sign up for C, either when you first enroll in Medicare or during the Open Enrollment Period, which is now and ends December 7.


Part C includes Medicare Advantage plans. What are they? Medicare Advantage plans are coverage offered by Medicare-approved private insurance companies. There are many of these companies and each has its own Ifs and Buts. Before you enroll, do your homework. Know your options and have a list of your wants and needs before you investigate individual plans.


First of all, you need to have Medicare Part A and B before you can sign up for Medicare Advantage (MA). You will still be charged a premium for Part B in addition to whatever premium may (or may not!) be charged by your MA company.
Second, you need to decide if you want to enroll in an HMO or a PPO. (By now you have no doubt realized that Medicare probably holds the dubious distinction for most use of abbreviations and acronyms, with the possible exception of the military.) What is the difference between the two?
HMO (Health Maintenance Organization). With HMO coverage, you are (mostly) limited to doctors, hospitals, and other providers that are “in network,” meaning they are approved by Medicare and they are the only caregivers that you can use. You will have a primary – in-network – doctor who oversees your care and will refer you to any specialists, if necessary. You may need to get approval before a treatment. An HMO may have coverage only in a specific geographic area.
PPO (Preferred Provider Organization). PPOs have fewer restrictions and may have coverage regionally, i.e., in a larger area. You will have a primary care doctor but you will not need referrals to see specialists. If you go out of network in an HMO, you may end up paying full price for services. With a PPO, you will pay more out of network but on a specified schedule and not for the entire amount.
HMOs and PPOs may or may not include Part D prescription drug coverage. If a plan you enroll in does not have drug coverage, you may not enroll is a stand-alone Part D plan.
MA plans, by law, have to offer all the benefits that Medicare offers. However, some may provide additional benefits in the form of extra coverage for vision, hearing and dental.

Here are questions you should know the answers to before you investigate an MA plan:
 Would an HMO or PPO be better for my needs?
 Do I need/want Part D coverage as part of the plan?
 Is my doctor in a network or will I have to change?
 Will an MA plan be better than Medigap coverage? (We will explain the differences in an upcoming blog.)
Here are questions you will want to know from the MA plan provider:
 What is the monthly premium?
 What are the co-pays?
 Is there an annual deductible?
 Is there an out-of-pocket spending limit?
 What hospital expenses are covered beyond traditional Medicare?
 What about emergency ambulance service?
 What about medical equipment?
 What routine medical exams are included?
Are you totally confused now? I am here to help you make your way through this morass of decisions. I know all the ins and outs – and Ifs and Buts – of Part C coverage and am ready to help!

Next: About Part C costs and a little about MA vs. Medigap opportunities and pitfalls.

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