The Advantages of Medicare Advantage (Part C) Plans
Medicare Advantage plans (Part C) were first introduced in 1997, and there is still misunderstanding surrounding these plans.
As a Medicare Advantage plan who strives to provide the best possible plans, Clover Health understands that education is the first important step in finding the right plan.
Exploring your Medicare options or turning 65? Have you heard about Medicare Advantage plans and want to know if they are the right choice for you? Are you a child looking to better understand Medicare to help your parents make the right healthcare decisions?
We want to help you fully understand Medicare Advantage (Part C) plans so that you can be confident in your healthcare decisions.
What are Medicare Advantage Plans
Medicare Advantage plans, also known as Part C, are Medicare-approved plans administered by private insurance companies that provide all the benefits of Original Medicare (Medicare Parts A and B), often with additional coverage.
Medicare Advantage is a bundle approach to Medicare, as it combines Medicare Parts (A, B, and D) all under one single plan (Part C). To learn more about the different parts of Medicare, click here.
Not only do most plans, like Clover, cover prescription drugs, but they also include additional benefits, like dental, vision, hearing, fitness programs, and over-the-counter items. These can make healthcare more affordable. Best of all, Medicare Advantage plans can have low or even $0 monthly premiums.
With such great benefits, shouldn’t everyone have a Medicare Advantage Plan? When it comes to Medicare, the best coverage is the coverage that’s right for you. Most importantly, not every Medicare Advantage plan is right for everyone. It’s important to choose a plan that fits your healthcare needs.
Compare Medicare Advantage (Part C) to Original Medicare
Medicare Advantage plans like those offered by Clover Health must include all Part A and Part B benefits.
|
BENEFITS |
ORIGINAL MEDICARE |
MEDICARE ADVANTAGE |
|
Doctor visits |
✔️ |
✔️ |
|
Specialist visits |
✔️ |
✔️ |
|
Hospitalization |
✔️ |
✔️ |
|
Hospital care |
✔️ |
✔️ |
|
Skilled nursing facility |
✔️ |
✔️ |
|
Nursing home care |
✔️ |
✔️ |
|
Home health service |
✔️ |
✔️ |
Many Medicare Advantage plans include additional benefits in their plans that members enjoy:
|
BENEFITS |
ORIGINAL MEDICARE |
MEDICARE ADVANTAGE |
|
Prescription drug coverage |
✔️ |
|
|
Out-of-pocket maximums |
✔️ |
|
|
Worldwide emergency coverage |
✔️ |
|
|
Dental |
✔️ |
|
|
Vision |
✔️ |
|
|
Hearing |
✔️ |
|
|
Over-the-counter items |
✔️ |
|
|
Rewards program |
✔️ |
|
|
Fitness program |
✔️ |
Extra benefits vary by plan.
With all that Medicare Advantage plans offer, it’s no wonder millions of Medicare beneficiaries are enrolled in a Medicare Advantage plan.
How Medicare Advantage (Part C) Works
With a Medicare Advantage plan, Medicare pays private insurance companies, like Clover Health, a set amount each month to administer the plan. These companies have a contract with Medicare and must submit the Medicare Advantage plans annually to Medicare for review and approval.
When you receive care, the Medicare Advantage plan is responsible for paying those claims. The plan, not Medicare, processes and pays your claims. The plan also works with your doctors, hospitals, and pharmacies on your behalf to ensure you receive the care you deserve.
How to Choose a Medicare Advantage Plan
Medicare Advantage (Part C) plans can be a wonderful way to manage healthcare costs and cover your healthcare needs, but only if you have the right plan. Medicare Advantage plans come with many different coverage options and price points, so choosing the right plan is vital. Fortunately, we are going to show you how.
Step 1. Know your coverage needs. Original Medicare covers basic health care needs, including hospital care and medical insurance, but for dental, vision, hearing, or prescription drugs, you will need a Medicare Advantage plan. Each plan will vary in coverage, so make sure to know your needs before purchasing a plan.
Step 2. Check the plan’s network of doctors, hospitals, and pharmacies. If you have a list of doctors or specialists you want to continue to see, make sure they are listed in the plan’s network before selecting it.
Step 3. Consider the prescription drugs you take regularly. If you need prescription drug coverage, check if the plan covers your prescriptions or if a viable alternative is listed.
Step 4. Compare costs. What will a Medicare Advantage plan cost you? Will it fit in the monthly budget? Also, consider current out-of-pocket expenses, deductibles, copays, and coinsurance. Would an advantage plan help alleviate those costs on a monthly basis?
Step 5. Consider your lifestyle and the extra benefits a plan offers. Some plans offer incentives, reward programs, and over-the-counter allowances that can add additional value to your life. Make sure to factor in the benefits of these programs.
After considering all of these things, you will be able to find a plan that lines up with your healthcare needs, your budget, and your lifestyle.
Who is Eligible for Medicare Advantage Plans and How to Enroll
To be eligible for a Medicare Advantage (MA) plan, also known as Part C, you must be enrolled in both Medicare Part A and Part B. However, to enroll in a plan, you must also live in the plan’s service area, which is based on the county where you live. There are some exceptions, and if you have employer or union coverage, you could lose eligibility if you join a Medicare Advantage plan.
Enrolling in a Medicare Advantage Plan is easy. You can simply enroll online or contact the insurance plan by phone. At Clover Health, we offer both enrollment options.
To learn about the many enrollment windows for Medicare Advantage, click here.
Learn More About Medicare in Your State
As a federal program, Original Medicare is the same in every state. However, Medicare Advantage plans will vary in each state and can even vary in each county. To learn more about what Clover offers in your state, check out our state-specific Medicare information.
