There are four basic parts of Medicare: A, B, C, and D. Each part helps pay for certain medical services.
Medicare Part C, better known as “Medicare Advantage”, comprises an “all in one” alternative to Original Medicare. These “bundled” health plans include Part A, Part B, and usually Part D all under one coverage umbrella.
Here are 5 things to know about Part C — Medicare Advantage:
- If you elect to go with a Medicare Advantage plan instead of Original Medicare, you still must enroll in parts A and B and pay the Part B premium. However, many Medicare Advantage plans do not charge an additional monthly premium. And a few MA plans even pay for part of your Part B premium.
- CMS, the federal agency which oversees Medicare, requires all Medicare Advantage plans to cover everything that Original Medicare covers. Some plans may have lower out of pocket costs and provide additional benefits that original Medicare does not cover like gym memberships and hearing, dental and vision care. These extra benefits can vary by plan.
- Most Medicare Advantage plans also include prescription drug coverage as part of the plan. You don’t have to pay for a separate Prescription Drug Plan like you do with Original Medicare.
- Medicare Advantage plans generally are either HMOs (health maintenance organizations) or PPOs (preferred provider organizations).
- With most HMO plans you typically must choose a primary care doctor who then directs your care and generates a referral if you require care from a specialist. For any service to be covered you must remain within the HMO’s network of participating providers and within the plan’s service area. Services received from non-network providers typically are not covered by the plan. PPOs typically offer more choice and greater flexibility. They typically offer a broader network of providers from which to choose, often without need of a referral. You also have the option of seeking care from a non-network provider, though in most cases you will pay higher cost for the out-of-network services.
More from The Medicare Basics Series: Read 5 things to know about Medicare Parts A, B, and D in these previous posts: