It goes by many names – Medicare Part C, Medicare Advantage, MAPD. No matter what you call it, you may be wondering what this type of plan covers and how it’s different from Original Medicare. In this blog, we’ll discuss all the details you need to know about Medicare Advantage. From how it works with Original Medicare to its cost and everything in between, this is your complete guide to Medicare parts explained.
If you have remaining questions after reading this article, let us know. Our Medicare consultants will be happy to clarify any details for you. Call us at (901) 460-7220, send us an email at firstname.lastname@example.org, or fill out the contact form on this page. You can also visit our frequently asked questions page here. Remember, our Medicare consultations are always completely free.
How Does Medicare Part C Work?
What is Medicare Advantage? Medicare Advantage gives you additional options when it comes to your Medicare. Sometimes called “Medicare Part C” or “MAPD,” Medicare-approved insurance companies provide Medicare Advantage. This plan is more like traditional insurance with a mix of copays and out-of-pocket provisions.
Medicare Advantage plans provide you with Part A and Part B coverage and may offer additional coverage, including dental, vision, hearing, or health and wellness plans. Most Advantage plans also include Medicare Part D, which covers prescription drugs (MAPD).
What Does Medicare Part C Cover?
Medicare Advantage covers everything Part A and Part B cover. MAPDs also include Part D for prescriptions. Advantage plans may have additional coverage, depending on the type of plan. Some things your Medicare Advantage plan might cover include:
- In-patient hospital stays and treatment (Part A)
- Out-patient medical services
- In-patient rehabilitation
- Limited home health care
- Doctor’s visits
- Laboratory tests, blood tests, and X-rays
- Durable medical equipment
- Mental health services
- Ambulance services
- Occupational therapy
- Prescription drugs
- Preventive care
- Additional benefits like hearing, vision, dental, OTC benefits, etc
Your Part C will depend on the specific plan and insurance provider you choose. To clarify which services are included in your plan refer to your MAPD documents or call Delta Benefits Group at (901) 460-7220.
How Much Does Part C Cost?
Typically, Medicare Advantage offers lower premiums than Medicare supplements, often priced at $0 per month. Many times, Part D is included in this coverage. Similar to a group or private insurance coverage, networks are utilized to hold down costs. This means that you are not allowed to go outside your network with Medicare Advantage plans without incurring additional charges. Your out-of-pocket costs will depend on your specific provider, but it typically ranges from $3,000 – $7,500. Your deductibles and copays will also depend on your specific insurance provider. Additionally, with Advantage plans, no medical underwriting is required.
Depending on your health needs, Medicare Advantage may be a good idea for you. Delta Benefits Group has access to all insurance providers throughout the nation, and we can help you secure the best MAPD for your health needs and budget.
Original Medicare Coverage Compared to Part C Coverage
Many people are curious about the differences between Original Medicare (Parts A, B, and D) and Medicare Advantage. Here’s how it breaks down in comparison:
Original Medicare: Parts A, B, and D (plus a Medicare Supplement)
- Part A is free
- For most people, Part B is $170.10 (for year 2022)
- Part D premiums will range from $7 to $139, depending on your prescriptions
- For most people, Medicare supplements will range from $85 to $110
- Original Medicare and your supplement have no networks and is accepted anywhere Medicare is accepted
- Does not include dental, vision, or hearing
Medicare Advantage (Part C)
- Part A is free
- Part B is $170.10 (for year 2022)
- Part D is included
- In most cases, there is a $0 premium
- Networks are utilized to hold down costs
- Includes dental, vision, hearing, gym, OTC benefits
How to Enroll in Medicare Advantage
Remember that not all Medicare Part C plans work the same way. Consult with a Medicare representative before you select your plan to find out what is right for you. There are certain times when you can enroll in Medicare Advantage or make changes to your plan:
- Initial Enrollment Period (IEP) – When you first become eligible for Medicare during your IEP, you can sign up for an MAPD. IEP is a seven-month period based on your 65th birthday, including the 3 months prior to the month you turn 65, your birth month, and the 3 months following your birth month.
- Annual Enrollment Period (AEP) – This is from October 15 – December 7, annually. You can enroll and amend your current MAPD during this period.
- Open Enrollment Period (OEP) – This is from January 1 to March 31, yearly. This period applies only to those enrolled in an MAPD. During this period, you can change your MAPD or go back to Original Medicare.
- Special Enrollment Period (SEP) – You qualify for this under certain circumstances, including if you move out of your service area, you are eligible for Medicaid, you qualify for Extra Help with Medicare drug costs, there is a declared disaster, or you are receiving care in a skilled nursing facility or long-term care facility.
How Do I Know If My Medicare Plan Is Right for Me?
Our Medicare representatives can help you understand if your Medicare plan is right for you. We can walk you through your options on the phone. Depending on your situation, there may be plans that are a better fit for you, including plans that cost less than what you are paying now, plans that cover your prescription costs, plans within networks that include doctors or pharmacies of your choice, and plans that offer additional benefits that Original Medicare does not (hearing, vision, dental, etc).
Should I Reach Out to a Medicare Representative?
A Medicare expert at Delta Benefits Group can help you find the right Medicare Advantage plan based on your specific needs and answer any questions you have about Medicare. If you need help, our reps are on standby waiting to walk you through your benefits.