Medicare Advantage

Part C At a Glance

Medicare Advantage, also known as Part C of Medicare, is a plan that offers additional Medicare coverage along with Parts A & B. These are also regulated by the government and sold through private companies; however, they are subject to heavier regulation and are incorporated with HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) networks. This means that you will have to see certain doctors and receive your care in certain facilities. Other types of plans that come with Medicare Advantage are PSO (Provider Sponsored Organization), POS (Point of Service), PFFS (Private Fee-for-Service), SNP (Special Needs Plan), MSA (Medicare Medical Savings Account). Medicare Advantage plans, premiums, and benefits vary by county in each state across the country. If your income is low enough to receive Medicaid, you can receive assistance in paying your out-of-pocket costs for a Medicare Advantage Plan. Special Needs Plans also have provisions for people with certain illnesses and income levels.

Optional Prescription Drug Coverage: Medicare Part D, which is prescription drug coverage, can be purchased separately along with Original Medicare, separately along with your Original Medicare and Medicare Supplement plan, or in combination with your Medicare Advantage (Medicare Part C ) plan.

Medicare Advantage in Depth

Medicare Advantage plans, also known as Medicare Part C, are private company plans that are contracted through the federal government. The companies receive fixed amounts per person to provide benefits to accompany Medicare Part A & B. You will still be responsible for paying your Part B premium (and your Part A premium if you have one) to the government. While all Medicare Advantage plans must provide you with Part A and Part B benefits, the way you receive your care will vary between companies. Some Medicare Advantage plans charge premiums, but some have $0 premiums. You may also be required to pay coinsurance and copays with your Medicare Advantage plan. Every Medicare Advantage plan has a maximum out-of-pocket limit, but they vary in amount. The 2016 cap for HMO plans is $6,850. Medicare Advantage plans are also not permitted to charge higher cost sharing amounts for services covered by Original Medicare. Most Medicare Advantage plan types are HMOs and PPOs.

Health Maintenance Organizations (HMOs): HMO plans have an established network of physicians and healthcare facilities to provide your care. They will not cover healthcare services performed outside of the network. Most HMOs will also require a referral to see a specialist.

Preferred Provider Organizations (PPOs): PPO plans also have established networks of physicians and healthcare facilities and charge fixed copays when using in-network resources. Some PPO plans allow recipients to receive care outside of the network, but recipients will be responsible for higher out-of-pocket charges.

You qualify to join a Medicare Advantage plan if you:

  • Have Medicare Parts A & B
  • Live within a plan service area (Plans vary by county. Not all counties will offer the same plans.)
  • You have not been diagnosed with ESRD (End-Stage Renal Disease)
  • There is an exception for people with ESRD in some Special Needs Plans; Some SNPs will accept you if you have ESRD if you require dialysis or a kidney transplant. These plans have specific requirements to offer coverage under these circumstances.

Medicare Advantage and Part D Prescription Drug Plans

If you are wanting Part D prescription drug coverage along with Medicare Advantage benefits, most of the time you will need to select a plan that offers Part D benefits within the plan. You can join a stand-alone plan if you are enrolled in any of the following:

  • Medicare Savings Account (MSA)
  • Private Fee-For-Service (PFFS) without prescription drug coverage
  • Cost Plan (not a Medicare Advantage plan; private health plan sponsored by an HMO that allows out-of-network services to be covered by Original Medicare)

Some employers or unions sponsor Medicare Advantage plans that you may be automatically enrolled into. You do have the choice to keep the plan, go to Original Medicare, or enroll into a different Medicare Advantage plan. If you choose to switch to Original Medicare or enroll into a different Medicare Advantage plan you do risk losing your employer benefits for yourself and your dependents. Be sure to speak with your employer or union before making any changes to ensure you do not lose any health benefits.

What Can I Expect to Pay with a Medicare Advantage Plan?

  1. Part B Premium. Even though your Medicare Advantage plan combines your Part A & B benefits along with your additional coverage, you still must pay your Part B premium (and your Part A premium if you have one). Some Medicare Advantage plans may assist in paying your Part B premium.
  2. Medicare Advantage Plan Premium. Many Medicare Advantage plans have $0 premiums; however, some Medicare Advantage plans do charge premiums. Depending on what plans are offered in your service area, you may or may not be responsible for paying a premium.
  3. Deductibles. Some Medicare Advantage plans charge deductibles for doctor visits, hospital visits, and prescription drugs. There are some plans available that do not; your service area will determine what is available to you.
  4. Copayments. You will typically have a set dollar amount you will pay when you see a doctor, or a copay. You will have this charge instead of coinsurance, which is a percentage of charges.
  5. Out-of-Pocket Cost Sharing Maximum. Medicare Advantage plans require an out-of-pocket maximum cost sharing amount. Out-of-pocket maximums vary from plan to plan, and are typically high. Your copays and deductibles are included in this amount and does offer you some protection from paying excessive amounts should you become ill or require costly treatments.

There are certain types of care that Medicare Advantage is not permitted to charge you more than Original Medicare. Some of these are dialysis, chemotherapy, and durable medical equipment. They can, however, charge you more for skilled nursing facility care, home health, and inpatient hospital services.

Most Medicare Advantage plans have networks that include only certain doctors you can see for your care. If you receive care outside of your network or do not follow the specific rules of your Medicare Advantage plan regarding how and where you receive your care, you can expect to pay more for these services.

What type of coverage do Medicare Advantage plans provide?

Medicare Advantage plans can be more affordable than Original Medicare, and must cover services that Original Medicare does- but you do not have the freedom in choosing your types of care, where you get your care, or who gives you your care. All Medicare Advantage plans have different restrictions, rules, and costs. Medicare Advantage plans can work well for people who do not need a lot of care. Medicare Plans do, however, have out-of-pocket maximums that can be high but offer you protection from excessive expenses should you require a more care or expensive treatment.

Medicare Advantage plans are not permitted to charge higher copayments for some services than Original Medicare, like chemotherapy and dialysis, but they are allowed to charge higher prices for other services like inpatient hospital care. These details will be amongst the additional rules and restrictions within your plan.

Medicare Advantage will only cover services you receive within the plan’s network of doctors, pharmacies, and hospitals. If you have certain hospitals, pharmacies, or doctors you prefer to use you should check with the plan before you purchase it to ensure your services will be covered. You may also be required to go through a series of steps to get prior authorization from the plan provider before you are able to receive certain types of care, like getting referrals from your primary care physician so you can see a specialist or receive other types of drugs or services.

If your Medicare Advantage closes, you will be required to go to a new Medicare Advantage plan or switch to Original Medicare. At this time, you could purchase a Medigap policy along with your Original Medicare to supplement the gaps in coverage that Original Medicare leaves. Medigap policies can only be purchased with Original Medicare.

Different Types of Medicare Advantage Plans

Most Medicare Advantage plans are HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations).

Other available types are SNPs (Special Needs Plans), PSOs (Provider Sponsored Organizations), and MSAs (Medical Savings Accounts).

Each of these plans have different qualifications, rules, and restrictions. Two plans of the same type, such as two PPOs, will most likely not operate in the same nature.

It is very important to gain clarification on the specific rules for each plan. Plans may be very similar but one small difference can affect your care in very big ways. Be sure you know exactly what you are signing up for when you choose to join a Medicare Advantage plan.

Medicare Advantage and Retiree Insurance

If you have retiree insurance and enroll in a Medicare Advantage plan, Medicare Advantage will pay first and your retiree insurance will pay second. Some retiree benefits provide additional benefits to your Medicare Advantage plan as well as pay deductibles and copays. Retiree benefits are different for each person, but you should check with your benefits to see exactly how they may work with Medicare Advantage plans.

Checklist: Questions to ask before enrolling in a Medicare Advantage Plan

Network Questions

  • Are my doctors, pharmacy, and hospital of choice in the plan network?
  • Are the doctors I would like to see in the future in the plan network? Do they accept new patients with this plan?
  • If they aren’t in the network and I decide to see them, will my visits be covered?
  • Do my doctors feel this plan is a good fit for me?
  • If my doctors, pharmacies, hospitals, and specialists are not in this network, which ones are?
  • Who are my choices for a PCP (Primary Care Physician)?

Specific Rules Questions

  • Will I need a referral from my PCP to see a specialist?
  • Will my doctor need to get approval before admitting me to a hospital?
  • Does the plan offer additional benefits like hearing aids, vision, or dental care? Are there specific rules I must abide by to get them?

Prescription Drugs Questions

  • Does this plan provide prescription drug coverage?
  • Are the drugs I take on the plan’s list of drugs they cover (formulary)?
  • Does the plan have additional restrictions on drug coverage like requiring prior authorization or trying cheaper medications before they will cover my prescriptions? Do they have limits on the quantity of drugs I can receive at a time?
  • Will I have to meet a deductible before my prescriptions are covered?
  • What kind of prices will I pay for brand-name drugs vs. generic drugs?
  • What will my costs be during the Part D prescription drug coverage gap? (link to explanation)
  • Does the plan require I receive my drugs through mail order or can I use my pharmacy?
  • Are my prescriptions covered if I need to fill them while traveling?

Out-of-Pocket Cost Questions

  • How much is the plan's monthly premium?
  • Will my Part B and Part D premiums be higher because of my income? (those with incomes above $85,000 for individuals and $170,000 for couples will pay higher premium for Part B and Part D)
  • What is the plan’s maximum out-of-pocket amount? (If you are looking into a PPO, be sure to ask for both the in-network max out-of-pocket as well as the out-of-network max out of pocket)
  • What is my deductible?
  • What are my copayment amounts for PCP and specialist visits?
  • What are my costs if I choose to see a doctor or use a hospital that is out-of-network?
  • Would my copays be higher for home health care or hospital stays?

Service Area Questions

  • What is the service area that the plan covers?
  • Is coverage provided to me if I receive services outside of the plan service area?
  • If so, what kind?

If you have another benefit plan:

  • Does this plan coordinate with my current benefit plan, retiree, or employer coverage?
  • Will I lose my retiree or employer health coverage if I enroll into this plan?

How do the different Medicare Advantage networks compare?

Each Medicare Advantage plan’s network rules are different, but there are a few characteristics they commonly share. It is very important to find out the specifics of the plan you are looking into, but some general information is below.

HMOs: Typically need a referral to see an in-network specialist; cannot see an out-of-network doctor unless it is an emergency or you have a POS (Point of Service) option that permits you to receive care out-of-network

PPOs: Do not need a referral before seeing an in-network specialist; can see out-of-network doctors at a higher out-of-pocket cost unless it is an emergency.

Proof of Medicare Advantage Plan Coverage:

If you enroll in a Medicare Advantage plan instead of Original Medicare, you will use your plan membership card to show proof of coverage. You will not use the Original Medicare red, white, and blue card. You will need to present your plan card when you visit the doctor, hospital, and pharmacy if your plan has Part D prescription drug coverage.

Mandatory Plan Change Notifications

If you enroll in a Medicare Advantage plan, they are required to notify you if they make any changes during your plan year. Changes that are sometimes made are to networks and to formularies.

Network Changes:

Medicare Advantage plans typically have networks of doctors, hospitals, and Pharmacies that enrollees are required to use for their health care. If a provider is leaving the network, the plan is required to send written notices at least 30 days before the provider’s exit is complete.

Formulary Changes:

If changes are made to your plan’s drug formulary, you do have rights depending on why the change was made. Your plan is required to update the formulary in print as well as online, and if you will be affected by the changes they are required to send you a new formulary by mail.

  • Maintenance changes: Maintenance changes are changes made when a plan begins covering a generic drug instead of a brand-name drug, adds quantity limits upon warnings issued by the FDA, safety concerns, or to abide by clinical best practices. If the formulary is being changed due to maintenance, they are required to give you 60 days prior notice or a 60 day transition fill. If your plan makes makes a maintenance change to your formulary, they must either provide you with a 60-day transition fill or give you 60 days prior notice.
  • FDA Declares a Drug Unsafe: If the FDA declares that a drug is unsafe, the plan is able to remove the drug at any time but must notify those who will be affected.
  • Non-maintenance changes: Any other reason the plan is making the formulary change. If it is determined the drug they are eliminating is medically necessary for you, the plan must allow you to continue taking the drug for the duration of the year. The plan is also required to notify you by mail and inform you the drug is being removed from the formulary but your prescription will be covered for the duration of the year.

Care Coverage in the Event of Public Health Emergency or Disaster

Medicare Advantage and Part D prescription drug plans are must provide access of coverage to recipients in the event of a public health emergency or disaster. Once the disaster or public health emergency is over, plans are allowed to resume their standard policy. The federal government is the authority to declare and end disasters and public health emergencies. In these situations, plans are required to:

  • Allow you to receive care in out-of-network doctor’s offices, hospitals, and other healthcare facilities.
  • Apply the in-network cost sharing rate to your out-of-network services
  • Waive the referral requirement from your PCP (Primary Care Provider)
  • Waive your obligation to contact them prior to receiving certain types of prescription drugs or care that you would otherwise raise your costs
  • Cover drugs that are on the plan formulary but filled at out-of-network pharmacies when you cannot be expected to get the prescription at an in-network pharmacy.
  • Remove early refill restrictions
  • Fill the maximum supply at your request