Medicare Overview

Medicare Benefits

Choosing A Medicare Plan

Enrollment

Medicare Eligibility

Medicare Costs

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Medicare Part C – Medicare Advantage (Private Hospital
& Medical Insurance)

Medicare Part C, or Medicare Advantage, is the combination of Medicare Part A and Medicare Part B and may also include prescription drug coverage (Medicare Part D). Medicare Advantage is a Federal program but it is sold through private health insurance companies, such as UnitedHealth Group, AARP, Humana, and others in the form of a Medicare HMO, PPO or other plan types. Sometimes, Medicare Advantage plans contain additional benefits that are not included in the Original Medicare Part A and Part B plans, such as vision and dental coverage.

With Medicare Advantage plans, Medicare pays a fixed amount for your care every month to the insurance companies (for example, AARP or Humana). These private insurance companies must provide you with minimum health benefits set by Medicare.

Also, it is important to note that if you choose a Medicare Advantage plan, you may not purchase a Medicare Supplemental insurance plan (Medigap). You may only purchase Medigap with an Original Medicare Part A and Part B plan.

Types of Medicare Advantage Plans

• Health Maintenance Organization (HMO) – Medicare HMO plans cover Medicare Part A and Part B. In most HMOs, you can only go to doctors, specialists, or hospitals on the plan’s network except in an emergency. Your costs may be lower than in Original Medicare.

• Preferred Provider Organization (PPO) – Medicare PPO plans cover Medicare Part A and Part B. With a Medicare PPO plan, you typically pay less if you use doctors, hospitals, and providers that belong to the network. You can also use doctors, hospitals and providers outside of the network for an additional cost.

• Private Fee-for-Service (PFFS) – Medicare PFFS plans cover Medicare Part A and Part B. Medicare PFFS plans permit you to go to any Medicare-approved doctor or hospital that accepts the plan’s payment. The PFFS insurance plan, rather than Medicare, decides how much it will pay doctors for treating you and what your coinsurance or copay will be for the services you receive. Unlike with an HMO or PPO network, the doctor or hospital may start or stop accepting the PFFS plan’s payment at any time.

• Medical Savings Account (MSA) – Medicare MSA plans cover Medicare Part A and Part B. The MSA plans have two parts: 1) the first part is a high deductible Medicare MSA plan. This plan won’t begin to pay covered costs until you have met the annual deductible, which varies by plan. 2) the second part is a Medical Savings Account into which Medicare deposits money that you may use to pay healthcare costs.

• Special Needs Plan (SNP) – Medicare SNP plans are a special type of Medicare Advantage plan that provides all Medicare Part A and Part B healthcare and services to people who can benefit the most from things like special care for chronic illnesses, care management of multiple diseases, and focused care management.These plans may limit membership to people:

Note: In most cases, Medicare Advantage plans, especially HMOs and PPOs, include prescription drug coverage (Part D). These plans are commonly referred to as Medicare Advantage Prescription Drug Plans or MAPD. If you purchase a Medicare Advantage plan without prescription drug coverage you will need to sign up for a Medicare Part D plan separately if you want prescription drug coverage.