A CLOSER LOOK AT MEDICARE PART C (MEDICARE ADVANTAGE)

Medicare Advantage plans - also known as Medicare Part C - combine the coverage of Medicare Parts A & B (sometimes called "Original Medicare") with additional benefits. Most plans include prescription drug coverage. There are four main types of Medicare Advantage plans:

• Health Maintenance Organization (HMO)
  You receive all services from a plan's network of doctors and hospitals who work together to provide care.
• Point-of-Service (POS)
  This is a type of HMO plan that lets you receive certain services outside the plan's network, generally at a higher cost to you.
• Preferred Provider Organization (PPO)
  For all services, you can choose between in-network and out-of-network doctors and hospitals, but services outside the plan's network typically cost more.
• Private Fee-for-Service (PFFS)
  These are non-network plans. You can receive care from any doctor or hospital that accepts the plan's payment terms and conditions.

What's covered?

Medicare Advantage plans help cover:

• All the benefits of Medicare Part A, including hospital stays, skilled nursing care and home health care, but not hospice care. However, because you must be enrolled in Part A to get a Medicare Advantage plan, your Part A benefit helps cover some hospice care.
• All the benefits of Medicare Part B, including doctor visits, outpatient care, screenings and shots, and lab tests.
• Prescription drugs are often included in Medicare Advantage plans. Some Medicare Advantage plans may also include coverage for extra services such as hearing, vision and preventive care.

Are there limits to coverage?

Coverage limits vary by plan, so check the specific Medicare Advantage plan's details to see if there are any coverage limits or exclusions.

Plans that include prescription drug coverage may have additional restrictions such as the cost-sharing amounts you pay for your medications.

What doctors can I see?

This also varies by plan. In some plans (like HMOs), your health care is coordinated through a primary care physician who manages the care you receive from doctors, specialists and hospitals within the plan's network. These plans cover just the services you receive from network providers.

POS and PPO plans are coordinated care plans like HMOs, but these plans let you receive services outside of the plan's network without a referral, generally at a higher cost to you.

Non-network plans (like PFFS plans) let you receive care from any Medicare-eligible doctor or hospital that accepts the plan's payment terms and conditions. No referrals are needed. All of these Medicare Advantage plan types offer nationwide coverage for emergency care and urgent care. In these situations, you can go to the nearest doctor or hospital.

How much does it cost?

If you join a Medicare Advantage plan, you'll continue to pay your monthly Part B premium (and Part A premium, if you have one). In addition to this, some Medicare Advantage plans may charge their own monthly premium. Look at each Medicare Advantage plan's details to see the cost-sharing expenses such as deductibles, copays and coinsurance. How much you pay varies by plan, but some plans protect you from high cost sharing by limiting out-of-pocket expenses through a yearly limit. If your Medicare Advantage plan includes prescription drug coverage, you may have additional copays, coinsurance and costs you'll have to pay for your prescription drugs.

How do I enroll?

You can join a Medicare Advantage plan as soon as you become eligible for Medicare or during your initial enrollment period. Even though Medicare Advantage plans combine the coverage provided under Original Medicare, you still need to enroll in Medicare Parts A and B as a first step. Once you've joined Part A and Part B, you can't be refused coverage by any Medicare Advantage plans in your area that are accepting new members. However, special rules apply to people with end-stage renal disease. Each private insurance company that offers a Medicare Advantage plan handles the enrollment process for its plans. Contact the company directly and ask how to enroll.

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