Dear AMAC,
I keep hearing ads on television about Medicare Part C plans that offer additional benefits. I want to know exactly what these plans are and if they are worth it. I don’t want to lose the coverage I have now, but it would be nice to have some dental and vison benefits.
-Elaine (Stone Mountain, GA)
Dear Elaine,
Your question is one we hear every day, so you are not alone. We are bombarded with advertisements through printed mail, TV, and radio for Medicare Part C, also known as Medicare Advantage. But many are still unaware of what that is. Let’s break down what this coverage entails.
Medicare Advantage Plans are a type of Medicare health plan that replaces your Original Medicare Part A and B. Although your Original Medicare will not actually terminate, your Medicare Advantage Plan will be your primary and only insurance that will be used.
These plans cover hospital care, medical services, and prescription drugs under one plan; however, you can choose an Advantage Plan without drug coverage if you wish. Medicare Advantage Plans use a network of providers much like an HMO or PPO, so you will want to make sure any providers you currently see accept the plan’s terms. Unlike Medicare Supplement Plans, Medicare Advantage Plans are not portable. So, if you move to a new area you will have to change your plan.
Medicare Advantage plans usually have lower monthly premiums, or even no premium in most areas. But keep in mind that you will have copays, coinsurance and possibly deductibles as you use the plan for different services like lab work and hospital care. This is why they are often referred to as “pay-as-you-go plans.”
Medicare Advantage Plans can offer benefits over and above what Medicare covers, like dental, vision, acupuncture, fitness memberships, transportation, and over-the-counter benefits. A person may consider enrolling into a Medicare Advantage Plan if they are comfortable with paying copays in exchange for a lower premium and don’t mind using network doctors.
It is important to know that you may not have another Medicare health plan, Medicare Supplement, or employer coverage in addition to your Medicare Advantage Plan. It is either one or the other. So, if you do not want to lose your current coverage, you may want to investigate the Advantage Plans further to see if it is something that would benefit you instead of the coverage you have now.
Thank you, Elaine, for reaching out to your Medicare Advisors here at AMAC!
For help with Medicare plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or request a quote below!
One thing I haven’t seen mentioned in the comments is that, to my understanding, if you have Original Medicare and switch to a Medicare Advantage Plan, if you want to switch back to Original Medicare you will have to go thru ‘underwriting’. If you have any ‘pre-existing conditions’ you can be sure that original Medicare will probably deny you the opportunity to switch back and you probably wouldn’t be able to get approved for a Medigap plan also.
I’ve had an Advantage plan for 3-4 years after 10-11 years of buying high cost supplemental and drug plans. I have 0 premiums and my drug plan, some dental, vision, and some other perks are included. Each quarter I can order $75 in over the counter products like toothpaste, pain relievers, bandages, etc. free of charge. My drugs are mostly tier 1&2 so they are completely cost free if I order through my plan’s mail order pharmacy. Treatments and visits with my primary care doc are without copay. Specialists like cardiologists, back doctors, and dermatologists are $20 copay. Surgical procedures if done in the doctor’s clinic are $20 copay, but $150 in a surgery center. I’ve had no problems at all with selection for physicians or the specialists I’ve wanted. I live in the Dallas/Ft Worth metroplex and coverage by my plan in this area is plentiful and high quality. I believe that my Advantage plan has saved me a lot of money the last few years. Also, I could not ask for better medical care. I’m sure that there are probably other areas where there could be more limited selections for doctors or hospitals, but I’m glad I switched to Advantage from regular Medicare with separate supplements and drug plans.
Thank you. This helped me understand Advantage plans.
Left out importent things like you are essentially turning all of your Healthcare decisions over to the insurance company and it’s network providers, and that company has a profit incentive to minimize your care. The choice of providers in various areas may be very limited and in rural areas may require long distances to get care.
You must remember it will cost you more if you get an illness like cancer, bills are split roughly 80-20
with you paying 20 percent+ copays. We had an Advantage plan and when my wife got cancer, we ended up 20% of $8000.00 chemo bills ! That adds up quickly. Because you can’t get a supplement
plan under that plan. It could cost you a lot more when and if you get sick.
Thank You. This is very helpful.