Medicare Part C (Medicare Advantage)

Medicare Advantage option

With this option you enroll in a health plan (called Medicare Advantage) through a private insurance company. The insurance company guarantees to provide you with all of the benefits you would normally receive under Original Medicare. In fact, they are required by law to at least cover that much. The Medicare Advantage company then manages your care and receives a subsidy from Medicare to do so.

Many Medicare Advantage plans cover more than just your Original Medicare benefits in order to make it more attractive to enroll. For example, they might offer coverage for items like dental or vision which are generally not covered by Medicare. With this option you do not keep your Original Medicare.

Medicare Supplement option

With this option you keep your Original Medicare benefits and purchase an additional insurance policy from a private insurance company to fill in the “gaps” in your Medicare coverage. 

This rest of this page will cover the details of the Medicare Advantage option and whether or not it is a good choice for RVers .

For more details on option #2 (Medicare Supplement), please check out our page dedicated to Medicare Supplement Insurance by clicking here.

Medicare has 4 parts

  1. Part A is your benefit for inpatient hospitalization.
  2. Part B is your medical benefit for things like doctor visits and outpatient procedures and tests.
  3. Part C is Medicare Advantage.
  4. Part D is Prescription Drug coverage.

 

**In 2016 most people pay $104.90 per month for Part  B

 

Whenever you hear the term “Original Medicare” it is referring to Medicare Part A and Part B only. That’s what you get when you enroll in Medicare and receive your red, white, and blue Medicare card.

Medicare Advantage Insurance

Technically, you are still enrolled in Medicare Parts A and B when you enroll in a Medicare Advantage plan but you are transferring the responsibility of those benefits to a private insurance company rather than Medicare. Medicare will then pay the Medicare Advantage company a monthly amount to manage your care.

Why would anyone do that? Well, with the expectation of getting more benefits, of course! A Medicare Advantage plan will sometimes provide (but not always) more benefits than just Original Medicare. You might get extra benefits like these…

  • Lower deductibles than Original Medicare
  • Lower co-insurance than Original Medicare
  • Dental
  • Vision
  • Prescription drugs
  • Fitness memberships

 

So, why doesn’t everyone enroll in a Medicare Advantage plan? There are several reasons (especially for RVers) Medicare Advantage might not be a good choice which we discuss at length on this page. But, in short, here are the main pitfalls of a Medicare Advantage plan:

 

  • Not completely portable: most of them require you to see doctors in the plan’s network to maximum your benefits.
  • Not guaranteed-renewable: A Medicare Advantage company can decide to not offer your plan in any given year.
  • You could be stuck with a plan you don’t like: Medicare Advantage plans have strict periods of enrollment and dis-enrollment (generally October 15-December 7, exceptions apply).
  • Benefits change: Medicare Advantage plans renegotiate contracts with Medicare each year, often resulting in benefit changes.
  • Cost: In some areas of the country a Medicare Advantage plan costs more than a Medicare Supplement plan.

Types of Medicare Advantage plans

If a Medicare Advantage plan includes your Part D prescription benefits then it is called a…”Medicare Advantage w/Prescription Coverage (MAPD)”

If it does not include your Part D prescription coverage then it is simply called…”Medicare Advantage (MA)”

Within the Medicare Advantage program you might find one or more of these different types of plans available in your area…

Preferred Provider Organization (PPO)

With a PPO plan you generally have your choice of doctors and hospitals, but you pay less for services if you use doctors and hospitals in the plans network. You may be required to use doctors and hospitals in your domicile state. There are some PPO Medicare Advantage plans that we recommend for RVers. Be sure and check with us before enrolling in one!

Health Maintenance Organization (HMO)

With a HMO plan you generally are required to use the doctors and hospitals within the plans network only. Your coverage will be limited to a specific service area within the state you purchased the plan in. You will have limited or not benefits while traveling. You must establish and use a primary care physician. We generally do not recommend RVers enroll in these plans.

Private Fee For Service (PFFS)

With a PFFS plan you can generally go to any provider who is willing to accept the plans terms and conditions. There are no networks or contracts for doctors and hospitals. A doctor can refuse to accept your PFFS plan at any time, even if he or she had previously accepted it. There are some PFFS Medicare Advantage plans that we recommend for RVers. Be sure and check with us before enrolling in one!

Special Needs Plans (SNP)

SNP is designed for people with certain chronic conditions or disabilities. It usually has the same restrictions as a HMO plan does.

Costs

One of the biggest reasons people choose a Medicare Advantage plan over a Medicare supplement plan is that the perceived cost of a Medicare Advantage plan can be lower.  However, lower price does not always equate to lower cost. A Medicare Advantage plan might have a lower premium than a Medicare supplement plan; but when you factor in all of the costs associated with the Medicare Advantage plan then those premium savings can quickly disappear.

Since a Medicare Advantage plan is only required to offer you the same benefits you would already be getting under Original Medicare A and B, you could end up getting just that while paying additional premium for it! So, be sure and carefully review all of the benefits associated with a Medicare Advantage plan before decided it has a lower cost than a Medicare supplement plan.

 

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