Medicare Advantage

Medicare Advantage, or Medicare Part C, is an alternative option for potential enrollees who do not want to receive benefits under Original Medicare. Instead of being funded by the government, the plans are offered by a private insurance company that is contracted through the Center for Medicare and Medicaid. At minimum, they also offer the same level of coverage that both Medicare Part A and Part B provide. Medicare Advantage is a nice alternative to consider, but might not be for everyone.

One of the biggest benefits of the Medicare Advantage plan is that it gives you the option to obtain additional coverage items. This can include routine dental care, vision care, prescription drug coverage, or fitness center memberships. Another advantage of Part C is that average costs tend to be less. You will still be responsible for paying the Medicare Part B premium but may not have to pay a premium for the Advantage plan itself. Cost-sharing is another expense that is often lower than Original Medicare too.

A unique feature of the plan is that it is managed care and has networks of health care providers for the policyholder to use. The two options available are HMOs (Health Maintenance Organization Plans) and PPO (Preferred Provider Organization Plans). These plans rely on networks of medical facilities and providers to lower costs for beneficiaries. Depending on which option you choose, you may need to select a primary care physician to coordinate your care and write referrals.

Another difference between Medicare Advantage and Original Medicare is that Advantage plans tend to have prescription drug coverage worked into the policy where Part A and Part B do not share the feature. They also seem to have a lower limit to the maximum out-of-pocket expense that can be charged in a given year.

For many, choosing Medicare Advantage comes down to deciding whether a lower monthly cost makes up for the lack of availability. Unlike Original Medicare, Medicare Advantage beneficiaries are only allowed to seek medical attention from those within the network. There are usually additional fees or costs that are tacked onto the bill by going outside the network. One exception to this would be if there were a medical emergency.