Davison Insurance Group




What is Medicare Advantage/Part C?

stethoscope, hospital, doctor

Medicare advantage plans are another resource to get your Medicare part A and part B coverage. They are sometimes called “MA plans” or “Part C.” They are typically offered by Medicare approved private companies. The majority of Medicare Advantage Plans have built-in prescription drug coverage. For example: If you are currently on Original Medicare (Just Part A & B) or Medigap with a Stand-Alone Part D and decided to join MAPD (MA plan with Part D), once approved with a proper election, your Stand-Alone PDP will be canceled. However, there are some MA Plans with no built-in drug coverages. Those plans are typically designed for seniors with state prescription assistance programs or veterans with VA drug coverage or Tricare. You will also need health care providers who participate in the plans network. That way, you will have a limit on what you will have to pay out of pocket each year.

What are some of MA Plans/Part C Network?

  1. Health Maintenance Organization (HMO)
  2. Preferred Provider Organization (PPO)
  3. HMO-POS (Point of Service)

How the product works:

  1. Medicare advantage covers the gaps of Part A, plans are $0 to low premiums. Usually, there’re copays for hospitals.
  2. Plans are filed on an annual basis, can & do change
  3. There is a Max out of pocket on covered services.
  4. Provides additional benefits* such as dental, fitness, hearing, etc – (Vary by plan)

Original Medicare vs Medicare Advantage Plans

Original MedicareMedicare Advantage
CostPremiums, copays, deductible, and coinsurance.Premiums, copays, deductible, and coinsurance.
CoinsuranceMembers usually pay 20% of the total. (Based on the cost of service)Has a max out of pocket per year.
Members out of pocketMembers have no limits to spend.There’s a set max out of pocket per year.
Drug CoverageMust purchase a Stand-Alone PDP. (To avoid penalties)Most carriers have a built-in drug coverage.
Supplemental BenefitsNoneDental, vision, fitness tracker, discounted gym membership, and hearing aids. (Plans may vary)
Network ProvidersAny facility or PCP who accepts Medicare.Providers must be in network.

Who qualifies for Medicare Advantage Plans?

  1. People who are turning 65 or older with Part A and B.
  2. People who are under 65 with disability or chronic condition with Part A & B. (MA Special needs plans)

When can a person who qualifies for Medicare enroll into a Medicare Advantage/Part C?

  1. IEP (Initial Enrollment Period/Turning 65)
  2. AEP (Annual Enrollment Period/Oct. 15th – Dec. 7th)
  3. OEP (Open Enrollment Period/Jan. 1st – Mar. 31st)
  4. SEP (Special Election Period/Anytime*)

SEP*: Must have qualified Special Election such as:

  1. FEMA state/counties Natural disaster.
  2. Loss of Employment Health Group Coverage.
  3. Change of resident.

A full list of SEP can be found at Medicare.gov for further information.

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