Medicare Advantage Plans (Part C)

//Medicare Advantage Plans (Part C)
Medicare Advantage Plans (Part C) 2017-11-30T23:21:54+00:00

Medicare Advantage Plans (Part C)

When you turn 65, you have a 7-month window to sign up for Medicare. One of the biggest decisions you must make is to choose between Original Medicare (Parts A & B), or a Medicare Advantage Plan. With Original Medicare, you are asking your Medicare plan to pay for all of your doctor and hospital visits, testing, and related expenses. If you want prescription drug coverage or gap insurance, you will need supplement plans.

Medicare Advantage Plans Defined

Medicare Advantage DefinedIf you choose a Medicare Advantage Plan (or Medicare Part C), you are essentially asking a private health care company to manage your Medicare Plan. In such case, Medicare sends money that it would use to cover you to your insurer, and asks them to handle all of your claims and services. Medicare Advantage Plans combine all of the coverage provided by Medicare A, B, D, and any supplement you choose into one plan.

Your private insurer will negotiate rates on your behalf, and can save you significant money over the long term. When you need care, you will seek it through that company’s provider network, usually an HMO or a PPO. For this reason, you can expect to incur copays or coinsurance fees, and you may need to go through a primary care physician. If you choose to see a doctor outside your network, you may have to pay out of pocket.

As with original Medicare, Part C plans charge a monthly premium. However, Part C coverage is not standardized. Each individual has an opportunity to select a plan that is right for him/her. Although these plans must all pay for (at minimum) the services covered under original Medicare, these plans vary widely with respect to how much they charge for copays and coinsurance, and can include prescription drug coverage, dental care, eye care, and also additional protection for when your expenses accumulate beyond what original Medicare would pay.

For example, if you end up staying in the hospital for more than 60 days, unless you have a supplement plan, under Medicare A you would have to pay a daily deductible for your stay. However, under an Advantage Plan, you could include coverage that pays for those extended visits. In other words, Medicare Plan D and Medigap plans are not available to Medicare Advantage Plan holders, because when you choose your Medicare Advantage Plan, you can opt to include these services.


Medicare Advantage DefinedLike Medicare Part D Plans, Advantage Plans have the same three categories of enrollment: Initial Enrollment, Annual Enrollment, and Special Enrollment. Initial enrollment is the same for Part C as for parts A, B, or D: Medicare gives you a 7-month window when you turn 65, beginning three months prior to the month in which you turn 65, and including that month and the three that follow. If you choose not to sign up for Medicare C, you will not face a penalty; but if you also fail to sign up for Medicare A & B, then you could.

Advantage Plans last for one year. Each October, private insurers release a list of updates and changes to their advantage plans for the coming year. From October 15 through December 7, you have the opportunity to select a different plan. It is vital to take advantage of this period to review your plan as well as those offered by other companies. It is quite possible that you can find a similar plan with the same services (or even a better combination of services) for the same rate or less. Whether you switch plans or keep the same one, your new coverage begins on the following January 1st.

Special Enrollment periods occur whenever you have a change in life circumstances. If you move to a different county, you are given a limited window in which to select a new Advantage Plan. This is true in part because not every company keeps every plan active in every county. Medicare gives you the right to find new coverage and rates appropriate for your new location and circumstances. Medicare also provides a special enrollment window when you enter a long-term nursing facility, or when you lose creditable coverage (e.g. via loss of a job).


Unlike other forms of Medicare, Advantage Plans also have a window from January 1st through February 14th in which you can disenroll from the plan and return to Original Medicare. You can even select a prescription drug plan (Part D), and/or a Medicare Supplement. However, you may face penalties if you fail to meet certain criteria. In some cases, late enrollment can mean that you will face underwriting, which will take into account pre-existing conditions when charging your premiums.

Prescription Drugs

Examine your Medicare Advantage formularyAs with Medicare Part D, when you sign up for a Medicare Advantage Plan, you will need to examine your plan’s formulary. Each formulary is a list of drugs your plan covers, and each plan uses a ranking system to rate the drugs according to how expensive they are. These ratings are often called tiers; a lower-ranking prescription is generic and easy to cover, while a high-ranking drug is an expensive specialty drug. It is critical to understand that not every drug is ranked on the same tier in every plan; what is a tier 4 drug in one plan might only be a tier 2 drug in another. And just because two plans are with the same company doesn’t mean they have the same formulary. Knowing which plan covers all of your drugs while rating each one on a low tier is crucial to saving you money.

Choosing the Best Advantage Plan

Choosing the right Medicare Advantage planTo select a Medicare Advantage Plan, you must carefully examine all features of each plan you are considering, and estimate the cost of using those features. If you have prescriptions, you will want a plan that covers all of your medication. And of course, if you favor a certain doctor, you should check to see whether that doctor is within your plan’s provider network.

This evaluation requires a meticulous approach to weighing the cost of services with their value, as well as the likelihood that you will need them. Because these services and their costs change every year, and because your health needs do also, you must revisit your Advantage Plan every year. With so many companies and plans, this review will likely take a lot of time. And unless you are an expert in risk assessment, you may find yourself crunching numbers to no avail.

CAP Insurance Services will Find Your Best Plan

CAP Insurance Services monitors the various changes companies make in their plans every year so you don’t have to. Contacting us once a year to review your plan will save you a lot of time and money. In addition to understanding plan costs and benefits, we also have a solid understanding of each company’s ability to provide great customer service and deliver on its promises. Choosing CAP Insurance Services takes the stress and worry out of selecting a new Advantage Plan every year. Let us give you peace of mind you need to enjoy your golden years, and the confidence and security you need to face life’s challenges.

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