Medicare Plans and Medicare Coverage - GoMedicare

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Should You Choose Medicare Advantage (Part C) Instead of Basic Medicare?

Nearly three decades after the official creation of Medicare, Medicare Advantage (Part C) plans were created by Congress to allow Medicare's beneficiaries to choose to get their coverage from private health insurance companies.

Is Medicare Advantage a good option for you? The answer depends on what you're looking for and what you need.

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Medicare Rights
Since Medicare Advantage plans are still considered to be part of Medicare, they grant you the same rights that you would have under the original Medicare program, such as the right to appeal and not to be treated unfairly or discriminated against for any reason.
Coverage
Medicare Advantage, also called Medicare Part C, is required to provide the same basic coverage as basic or original Medicare Parts A and B. However, Medicare Advantage may provide additional benefits, such as dental and vision. It may also increase the coverage limits on certain items, while decreasing them on others.
Private Insurers
Medicare Advantage plans are managed by private insurers. What this means for you, as a potential beneficiary, is that they might not offer all of the same coverage that you would get from original Medicare in the same way. Although they have to conform to various Medicare standards, the private insurers are allowed to make their own decisions in terms of the premiums they charge, the copayments and deductibles they incorporate into their coverage, and so forth. This means that you have to find out from each insurer exactly what they offer under each policy.
Pre-Existing Conditions
Unlike with many other health insurance plans, you are allowed to enroll in a Medicare Advantage plan even if you have been diagnosed with a pre-existing condition. This is the hallmark of all Medicare programs: you cannot be turned down because of pre-existing conditions. The only exclusion here is end stage renal disease (ERSD), which has its own set of eligibility rules and is handled differently by Medicare.
Plan Network
Your Medicare Advantage plan may specify which service providers you may go to when you need a specific medical service. These providers form a "network" from which you may select whichever provider you feel comfortable with the most. For example, if you need to see a specialist, the plan will have a specific network of specialists from which you may choose. If you get your medical service from a provider that is not on the network, you will probably have to pay from your own pocket or there will be higher copayments involved.
Participation
If for any reason your plan decides that it no longer wishes to participate in the Medicare program, you will have to join a different Medicare health plan or you would need to revert to your original Medicare (Part A and Part B) policies to retain coverage. Your plan is required to send you a letter detailing the options available to you, although you generally revert to original Medicare automatically if this should happen.

Medicare Prescription Drug Coverage

For more information about Medicare Advantage and Medigap (Medicare Supplement) plan options, fill out the quote form above.

References

  1. Medicare.gov: The Official U.S. Government Site for Medicare. Retrieved September 17, 2010.
  2. Social Security Online. Retrieved September 17, 2010.

This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov.