Medicare Part C plans are frequently referred to as Medicare Advantage plans. Such plans, provided by private insurance companies, offer another choice for your Medicare health care coverage. Medicare Advantage plans are approved by Medicare.
You can join a Medicare Advantage plan if you meet the following criteria:
You have Medicare Part A and Part B
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You live in the service area of the plan
You do not have end-stage renal disease or permanent kidney failure that requires dialysis or a kidney transplant
What do Medicare Advantage plans cover?
Medicare Advantage plans provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage. In all types of Medicare Advantage plans, you are always covered for emergency and urgent care services. Medicare Advantage plans must cover all of the services that original Medicare covers except hospice care. Original Medicare covers hospice care even if you are on a Medicare Advantage plan.
Medicare Advantage plans may offer extra coverage, such as vision, hearing, dental or wellness programs. Most of them include Part D, prescription drug coverage. If you choose a Medicare Advantage plan that does not offer prescription drug coverage, you may enroll in a Medicare Part D plan. However, you cannot enroll in a Medicare Part D plan if your Medicare Advantage plan provides prescription drug coverage.
Medicare Advantage plan members pay two premiums, one for Medicare Part B and one for the Medicare Advantage plan itself. Medicare Advantage plans set their own rules, which may or may not require such things as referrals before seeing a specialist, or going to doctors or health care facilities that accept the plan for non-emergent care. These rules can change each year.
Do I need a Medicare Supplement plan?
You do not need to buy a Medicare Supplement policy (also called a Medigap policy) while you are on a Medicare Advantage plan. Such a supplement will not cover any deductibles, co-payments or co-insurance associated with your Medicare Advantage plan. If you have a Medicare Supplement and wish to join a Medicare Advantage plan you will want to drop your Medicare Supplement since it won't cover your co-payments or deductibles. Keep in mind that if you drop your Medicare Supplement, you may not be able to get it back.
Changes in 2011 include an annual cap on how much you pay for Part A and Part B services while covered by a Medicare Advantage plan. Each plan has a different cap so this should be considered.
There are different types of Medicare Advantage plans:
Health maintenance organization (HMO) plans
Preferred provider organization (PPO) plans
Private fee-for-service (PFFS) plans
Special needs plans (SNP)
The chart to the right illustrates the differences between the different plans.
David Zimmerman is consumer assistance division director at the North Dakota Insurance Department.