Medicare Part C - Overview

[Mack]

Medicare Part C is also called Medicare Advantage Plans. Medicare Advantage Plans are offered by private insurance companies that are approved by Medicare.

A Medicare Advantage Plan provides all of your Part A and Part B coverage. A Medicare Advantage Plan must cover all services that Original Medicare covers except hospice care, which is still covered under Original Medicare.

A Medicare Advantage Plan is not a medicare supplement plan. It may offer extra coverage such as dental, vision, or hearing coverage. Many include Medicare prescription drug coverage (Part D).

Under a Medicare Advantage Plan you usually pay one monthly premium (in addition to your Part B premium that you pay to Medicare). Medicare pays the insurance company a set amount each month for your care. The insurance companies must follow Medicare's rules, but they can charge different amounts for coverage and copayments. Most Medicare Advantage Plans operate at HMO's or PPO's where you must get services from their network of hospitals and doctors.

 

[TLH]

Medicare Part C is also called Medicare Advantage Plans. Medicare Advantage Plans are offered by private insurance companies that are approved by Medicare.

A Medicare Advantage Plan provides all of your Part A and Part B coverage. A Medicare Advantage Plan must cover all services that Original Medicare covers except hospice care, which is still covered under Original Medicare.

A Medicare Advantage Plan is not a medicare supplement plan. It may offer extra coverage such as dental, vision, or hearing coverage. Many include Medicare prescription drug coverage (Part D).

Under a Medicare Advantage Plan you usually pay one monthly premium (in addition to your Part B premium that you pay to Medicare). Medicare pays the insurance company a set amount each month for your care. The insurance companies must follow Medicare's rules, but they can charge different amounts for coverage and copayments. Most Medicare Advantage Plans operate at HMO's or PPO's where you must get services from their network of hospitals and doctors.

I and my wife both become eligible for Medicare this November and I have been researching this subject for about a month now. I have a question on Medicare Advantage plans regarding any coverage over the 80% the original medicare covers. It appears they cover the same as part A and part B as you said. But what about the rest of the 20% not covered? I cannot find an Advantage Plan yet that covers any of this expense. With so many surgery's now done as outpatients 20% of $10k is $2k that I would be responsible for, it that correct? I would pay these type amounts until I reach my max out of pocket expense which varies from $4 to $7k?

Most of my research on MA Plans has generated more negative rather than positive comments. It seems that there is no hospital or medical gap coverage on MA Plans and I could be left with large bills to pay myself, but he monthly premiums are less or zero. This seems strange since there are many Medicare Supplemental plans just for the purpose of covering the 20% medicare doesn't pay. Do I have a correct understanding of this or am I missing something or just not found the right Advantage Plan yet? Are there Advantage Plans that have better coverage?

Thanks for the forum,
Terry

 

[Mack]

I and my wife both become eligible for Medicare this November and I have been researching this subject for about a month now. I have a question on Medicare Advantage plans regarding any coverage over the 80% the original medicare covers. It appears they cover the same as part A and part B as you said. But what about the rest of the 20% not covered? I cannot find an Advantage Plan yet that covers any of this expense. With so many surgery's now done as outpatients 20% of $10k is $2k that I would be responsible for, it that correct? I would pay these type amounts until I reach my max out of pocket expense which varies from $4 to $7k?

Most of my research on MA Plans has generated more negative rather than positive comments. It seems that there is no hospital or medical gap coverage on MA Plans and I could be left with large bills to pay myself, but he monthly premiums are less or zero. This seems strange since there are many Medicare Supplemental plans just for the purpose of covering the 20% medicare doesn't pay. Do I have a correct understanding of this or am I missing something or just not found the right Advantage Plan yet? Are there Advantage Plans that have better coverage?

Thanks for the forum,
Terry

Hi Terry,

Welcome to mymedicareforum.com!

Medicare Advantage Plans cover all of your health care needs, replacing original Medicare and the need for a Medicare supplement plan. The extent of coverage provided is dependent on each plan. I don't really have experience personally with Medicare Advantage because I looked at it and decided that original Medicare plus a Medicare Supplement plan was more suited for my circumstances.

But I will attempt to answer your question based on my understanding of Medicare Advantage. First of all, Medicare Advantage Plans will vary by both the state you are located in and the company that offers the plan. Think of a Medicare Advantage Plan as a HMO. You must use the doctors and hospitals with the network of the plan. The networks are usually confined to the general location where you live, usually a metro area, or perhaps a larger area, but usually smaller than the full state. They can offer offer coverage that is usually cheaper than the combintation of Medicare plus a Medicare supplement plan because the insurers have contracts with the doctors and hospitals in their networks for reduced rates.

The disadvantage is that you must use the network. Which means if you travel a lot, or spend time in different states, or just decide you don't like the hospitals or doctors in the network then you are stuck with them. Your choices are limited. Of course you have an opportunity to change every year during open enrollment, but that is a lot of trouble to become familiar with a new company and their procedures.

Still if, after reviewing a plan, it meets all your needs, a Medicare Advantage plan can be a cost savings over original Medicare and a Medicare Supplement plan.

Also some Medicare Advantage plans offer prescription drug coverage, which would eliminate you having to purchase a separate Part D plan.

I suggest you spend some time with the Medicare Plan Finder at:

https://www.medicare.gov/find-a-plan/questions/home.aspx

Also you said you were eligible in November. If you mean you turn 65 in November then you need to go ahead and sign up now for Medicare since it takes4-6 weeks to get your Medicare card. You can not purchase any type of Medicare Advantage Plan, Supplement Plan, or Prescription Drug Plan until you get your Medicare card.

If however you mean you turn 65 in February then you are on the right track to sign up in November! I can say that signing up on line is easy, I have done that, and it didn't take long at all.

Hope this helps some.

 

[TLH]

I and my wife both become eligible for Medicare this November and I have been researching this subject for about a month now. I have a question on Medicare Advantage plans regarding any coverage over the 80% the original medicare covers. It appears they cover the same as part A and part B as you said. But what about the rest of the 20% not covered? I cannot find an Advantage Plan yet that covers any of this expense. With so many surgery's now done as outpatients 20% of $10k is $2k that I would be responsible for, it that correct? I would pay these type amounts until I reach my max out of pocket expense which varies from $4 to $7k?

Most of my research on MA Plans has generated more negative rather than positive comments. It seems that there is no hospital or medical gap coverage on MA Plans and I could be left with large bills to pay myself, but he monthly premiums are less or zero. This seems strange since there are many Medicare Supplemental plans just for the purpose of covering the 20% medicare doesn't pay. Do I have a correct understanding of this or am I missing something or just not found the right Advantage Plan yet? Are there Advantage Plans that have better coverage?

Thanks for the forum,
Terry

Hi Terry,

Welcome to mymedicareforum.com!

Medicare Advantage Plans cover all of your health care needs, replacing original Medicare and the need for a Medicare supplement plan. The extent of coverage provided is dependent on each plan. I don't really have experience personally with Medicare Advantage because I looked at it and decided that original Medicare plus a Medicare Supplement plan was more suited for my circumstances.

But I will attempt to answer your question based on my understanding of Medicare Advantage. First of all, Medicare Advantage Plans will vary by both the state you are located in and the company that offers the plan. Think of a Medicare Advantage Plan as a HMO. You must use the doctors and hospitals with the network of the plan. The networks are usually confined to the general location where you live, usually a metro area, or perhaps a larger area, but usually smaller than the full state. They can offer offer coverage that is usually cheaper than the combintation of Medicare plus a Medicare supplement plan because the insurers have contracts with the doctors and hospitals in their networks for reduced rates.

The disadvantage is that you must use the network. Which means if you travel a lot, or spend time in different states, or just decide you don't like the hospitals or doctors in the network then you are stuck with them. Your choices are limited. Of course you have an opportunity to change every year during open enrollment, but that is a lot of trouble to become familiar with a new company and their procedures.

Still if, after reviewing a plan, it meets all your needs, a Medicare Advantage plan can be a cost savings over original Medicare and a Medicare Supplement plan.

Also some Medicare Advantage plans offer prescription drug coverage, which would eliminate you having to purchase a separate Part D plan.

I suggest you spend some time with the Medicare Plan Finder at:



Also you said you were eligible in November. If you mean you turn 65 in November then you need to go ahead and sign up now for Medicare since it takes4-6 weeks to get your Medicare card. You can not purchase any type of Medicare Advantage Plan, Supplement Plan, or Prescription Drug Plan until you get your Medicare card.

If however you mean you turn 65 in February then you are on the right track to sign up in November! I can say that signing up on line is easy, I have done that, and it didn't take long at all.

Hope this helps some.

Mack,
Thanks for the info, as you suggested I used the Medicare Plan Finder and it is a very good tool. To answer your question we turn 65 in November and both my wife and I have received our Medicare Cards that shows effective dates of 11/1/11, that what started my research on all this.

I am looking at the Advantage plans that are the PFFS type that can be used more widely with less restrictions to providers. I have checked with our family doctor and he accepts the PFFS plans of the plans available in my area. Several plans do offer prescription coverage and I entered our prescriptions on the Medicare Plan finder and the results were satisfactory, actually quite good for no extra charge and no deductible.

Any idea how many people choose Advantage Plans compared to keeping the Original Medicare? Wonder what the ratio of the members here on this board are? Do most have Original Medicare and a Plan D. Basically I'am just trying to determine if others find the Advantage Plans a good alternative and choose them.

Most agents that sell Medicare Supplemental coverage plans do not speak favorably of the Advantage Plans. What I trying to determine is that because they are not as good or because that's not what they sell to make a living,

Thanks,
Terry

 

[Mack]

Hi Terry,

From what I can gather around 25% of those eligible for Medicare are enrolled in Medicare Advantage. The benefit is a lower price. The disadvantage is reduced coverage. So it is a matter of personal choice, just do your research. And if you find that your plan is not right for you, then you can change during the annual open enrollment period.

Here is an article that is easy to understand about Medicare Advantage:

Read Article

 

[Miguel A. Claudio Navarro]

Cancer Hospital

Greetings

I would like to obtain information regarding how medicare make payments to Cancer Hospitals. I found the TEFRA Limit Cost explanation but I don't understand very well.

Please help

Thanks

 

[arihalli]

Hi TLH:

I will just give you my experience with the plans.

I turned 65 this past January. I signed up for a Medicare Advantage Plan from UHealthcare. When i rec'd it, i found that several specialists in town were not part of the network. The drug coverage was not terrific.

As far as paying the 20% balance of bills -- most of these MA plans have caps. And if you go to a hospital, you pay the first 5 or so days at a rate (say, $300 per day if memory serves me correct). And then they pay. And if you reach the cap --- say $4000-6500 depending on the plan, for that year..... then the MA plans pays everything after that for the rest of the year regardless.

I left the plan and went to Supplement Part N almost a month into getting my MA plan. I pay $121 supplement monthly (i am in NY, so as Mack mentions, the costs can vary). But i have the peace of mind that i can go to any MD, anywhere that takes Medicare. That includes the Cleveland Clinic, Mayo Clinic and any MD i researched. As well, of course, as those in my hometown of Binghamton.

Apparently, if one is reasonably sure that they will have no problems or many Dr. visits, then there is some $$ to be saved with MA. But if one wants the peace of mind knowing they are completely covered for EVERYTHING -- take the supplemental. I have Hx of cardiac problems. I now have no relucatance in going to the ER if i feel i might have Angina. Its simply covered. (Well, i do have a $147 deductible for the whole year and a small pay for MD visits) but this is negligible costs over and above the monthly premium. Part N supplemental is like driving in a cadillac and MA is like, to me, driving in a Fiesta. Nothing wrong with either - if they get you to where you want to go.

One other thing. If you have a Supplement (besides Medicare) you need to sign up for Part D. That is the drug plan. That can range from $30 bucks on up.
My experience with these plans? They are terrible. My United Healthcare plan for 2016 has a $360 deductible for the year. As well as $550 in premiums. So i have to pay approx $900 before i can get a Nexium paid for. And, of course, one has to research the formularys for each Part D. If any of your drugs are in Tier 1 or 2 then they are almost free. Tier 3 drugs are usually $45 for 3 months (for me using the UHealthcare mail order). But if you fall into a Tier 4 drug you might need find a substitute as they can start getting expensive.
And if you skip the Part D for even a year and decide not to pay premiums on it - you pay a small but regular monthly penalty for the rest of your life according to the calculation of the gov't. Its relatively easy to figure the calculation. If someone wants to know they can You tube it from Medicare or i will send them the You tube site.

The long and short is that MA can be a real hassle while Supplement, in my opinion, you just flash your card and can go for medical treatment anywhere anytime. That is my interpretation after a year of having Supplement N. Hope this helps.

 

[mattspits]

If you go the route of a Medicare supplement, you should compare your Medicare Part D drug plan annually during the AEP.

Here's a simple youtube video showing how you can use Medicare.gov to shop Medicare Part D plans in under 3 minutes!

Hi TLH:

I will just give you my experience with the plans.

I turned 65 this past January. I signed up for a Medicare Advantage Plan from UHealthcare. When i rec'd it, i found that several specialists in town were not part of the network. The drug coverage was not terrific.

As far as paying the 20% balance of bills -- most of these MA plans have caps. And if you go to a hospital, you pay the first 5 or so days at a rate (say, $300 per day if memory serves me correct). And then they pay. And if you reach the cap --- say $4000-6500 depending on the plan, for that year..... then the MA plans pays everything after that for the rest of the year regardless.

I left the plan and went to Supplement Part N almost a month into getting my MA plan. I pay $121 supplement monthly (i am in NY, so as Mack mentions, the costs can vary). But i have the peace of mind that i can go to any MD, anywhere that takes Medicare. That includes the Cleveland Clinic, Mayo Clinic and any MD i researched. As well, of course, as those in my hometown of Binghamton.

Apparently, if one is reasonably sure that they will have no problems or many Dr. visits, then there is some $$ to be saved with MA. But if one wants the peace of mind knowing they are completely covered for EVERYTHING -- take the supplemental. I have Hx of cardiac problems. I now have no relucatance in going to the ER if i feel i might have Angina. Its simply covered. (Well, i do have a $147 deductible for the whole year and a small pay for MD visits) but this is negligible costs over and above the monthly premium. Part N supplemental is like driving in a cadillac and MA is like, to me, driving in a Fiesta. Nothing wrong with either - if they get you to where you want to go.

One other thing. If you have a Supplement (besides Medicare) you need to sign up for Part D. That is the drug plan. That can range from $30 bucks on up.
My experience with these plans? They are terrible. My United Healthcare plan for 2016 has a $360 deductible for the year. As well as $550 in premiums. So i have to pay approx $900 before i can get a Nexium paid for. And, of course, one has to research the formularys for each Part D. If any of your drugs are in Tier 1 or 2 then they are almost free. Tier 3 drugs are usually $45 for 3 months (for me using the UHealthcare mail order). But if you fall into a Tier 4 drug you might need find a substitute as they can start getting expensive.
And if you skip the Part D for even a year and decide not to pay premiums on it - you pay a small but regular monthly penalty for the rest of your life according to the calculation of the gov't. Its relatively easy to figure the calculation. If someone wants to know they can You tube it from Medicare or i will send them the You tube site.

The long and short is that MA can be a real hassle while Supplement, in my opinion, you just flash your card and can go for medical treatment anywhere anytime. That is my interpretation after a year of having Supplement N. Hope this helps.