Medicare Part C - Medicare Advantage

Medicare Part C

Most Medicare Advantage plans combine Part A - Hospital Service, Part B - Medical Services and most plans will include Part D - Prescription drug. Medicare Advantage plans are offered by private companies that Medicare approves. Approved plans must provide coverage for all of the same services covered by Original Medicare including emergency and urgent facility care. In addition, an Advantage plan has a yearly out-of-pocket maximum which Original Medicare does not. Medicare Advantage plans may also provide coverage for other services not included in Original Medicare such as routine dental, vision, hearing as well as health and wellness programs.

Who is Eligible to Enroll?

  • Anyone entitled to Medicare Part A
  • Is enrolled in Medicare Part B
  • Permanently resides in the service area of the plan
  • Does not have End Stage Renal Disease

There are several different types of Medical Advantage Plans

  • Health Maintenance Organization (HMO) - In most HMO plans, you can only go to doctors and hospitals in the plan’s network, except in urgent or emergency situations.
  • Health Maintenance Organization – Point of Service (HMO-POS) - HMO-POS has a network of doctors and hospitals, however, they do have limited ability to go outside of the network, generally for higher costs, except in urgent or emergency situations.
  • Preferred Provider Organization (PPO) - PPO plans allow you to go outside of their network of doctors and hospitals, but it will generally cost you more in copays and coinsurance, except in urgent or emergency situations.
  • Special Needs Plan (SNP) - SNP plans generally require you receive care from a network of doctors and hospitals, except in urgent or emergency situations. SNP plans also carefully manage and coordinate your care to make sure your special needs and orders are being treated and adhered to properly. Not all plans are available in all areas. SNP plans are for specific groups of people, such as those with Medicare and Medicaid, those that live in a nursing home, or those that are diagnosed with certain chronic, disabling conditions such as diabetes and heart disease.

You Still Have Medicare

Even though you are enrolled in a Medicare Advantage plan, you still have Medicare and must continue to pay your Medicare Part B premium. The companies that offer Medicare Advantage Plans receive a fixed amount each month from Medicare to administer your coverage. In order to be contracted with Medicare, they must follow specific rules established by the Center for Medicare and Medicaid Services (CMS). Although each plan receives the same amount for administering your coverage. The plans may charge different amounts for premiums and other out-of-pocket costs and they may have different networks of doctors and hospitals. They also may have different rules for how you can obtain treatment – for instance, whether or not you need a referral to see a specialist or whether you’re required to see specific doctors or go to specific hospitals.

Medicare Advantage plans are annual contracts and may change every year. You would be notified by October 1st about the changes to the plans for the upcoming year so you can add, drop, or change plans if necessary.

Need Help?

Rhodes-Warden Insurance has three convenient office locations to serve you and we make it easy to reach us. Call us at (541) 258-2131 during our business hours of Monday through Friday, 8:30 a.m. to 5:00 p.m. or simply complete our Contact Request form above and we will call you to schedule an appointment at one of our offices in Lebanon, Albany or Stayton, Oregon.