What is a Medicare Advantage (Part C) plan?

There’s a lot to consider when choosing Medicare coverage, especially with so many Medicare plans to choose from. While most people are familiar with Original Medicare, there are other Medicare options like SCAN, which is a Medicare Advantage plan. In fact, more than half (51%) of people with Medicare are enrolled in Medicare Advantage plans, saying they like the low costs and broad healthcare coverage their plans offer. If you’re looking at your Medicare options, here’s the information you need to know about Medicare Advantage.

Original Medicare Includes Parts A and B

To understand Medicare Advantage, you first need to know the different parts of Original Medicare.

What is Medicare Part A?

Medicare Part A is the hospital insurance part of Medicare and helps cover:

• Inpatient care in hospitals
• Skilled nursing facility care
• Hospice care
• Home health care

What is Medicare Part B?

Medicare Part B is the medical insurance part of Medicare and builds on the benefits of Part A by helping cover services such as:

• Doctor visits
• Lab tests
• Outpatient care
• Preventive care
• Medical supplies

What is a Medicare Advantage (Part C) plan?

A Medicare Advantage plan (also known as “Part C”) is a Medicare-approved plan offered by private health insurance companies. These plans provide all the same services offered by Original Medicare. In addition, Medicare Advantage plans typically offer additional services and benefits beyond Original Medicare, such as fitness programs, hearing aids, dental, vision care, and more. Some also include Part D prescription drug coverage.

What is Medicare Part D?

Medicare Part D helps cover the cost of prescription drugs. Prescription drug plans are offered by private insurance companies that contract with the federal government. All plans must cover a wide range of prescription drugs that people with Medicare take. Each plan will have its own formulary, or list of covered drugs.

Are there different types of Medicare Advantage plans?

There are several types of Medicare Advantage plans, the most common of which include:

• Health Maintenance Organization plans (HMOs), which typically cover services that are provided by doctors, hospitals and other healthcare providers that are in the plan’s network.
• Preferred Provider Organizations (PPOs), where you have flexibility to use providers inside or outside of the plan’s network.
• Special Needs Plans (SNPs), which are plans for people with certain chronic conditions like diabetes, heart or lung disease, or for people who receive both Medicare and Medicaid, or who may live in a nursing home.

Why enroll in Medicare Advantage?

Medicare Advantage plans offer many benefits that can make it the right plan choice for you, including:

• Extra benefits — Medicare Advantage plans may include some cost savings toward hearing, dental, and vision care, fitness and transportation benefits, and other benefits which aren’t covered by Original Medicare.
• Low costs — Many Medicare Advantage plans have low or no monthly premiums, and offer many services for no or low copayments. You do have to continue to pay your Medicare Part B premium.
• Spending caps — The Maximum Out of Pocket puts a cap on how much you will pay out of pocket for covered hospital and medical services each year. 
• Drug coverage — Many people enrolled in Medicare Advantage plans have prescription drug coverage as part of the plan.
• All-in-one care — You can get your hospital, medical, and drug benefits through one insurance company. This means less paperwork and one contact for questions.

Who qualifies for Medicare Advantage?

Anyone who is enrolled in Original Medicare (Part A and Part B) may be eligible to sign up for a Medicare Advantage (Part C) plan.

What should you consider before enrolling in a Medicare Advantage plan?

There are a lot of extra benefits that come with a Medicare Advantage plan, which can be very attractive. But make sure to check the basics before deciding on a plan. For example:

• See if your doctors and choice of hospital are included in the Medicare Advantage plan’s network. If your current doctor is not included, are you open to switching to a new doctor?
• Review the plan’s formulary (list of covered drugs) to see if the prescriptions you take are included
• Find out if the plan has:
  • Monthly premiums
  • Any copayments for various services
  • Any out-of-pocket limits (the lower the out-of-pocket limit, the better)
• Finally, look at the plan’s star ratings for quality care and service. Every year, Medicare evaluates plans based on a five-star rating system. The higher the rating the better. Star ratings are a good thing to consider if you are deciding between Medicare Advantage plans.

If you don’t have a Medicare Advantage plan, take a look at the benefits, comprehensive coverage, award-winning service, and more offered by SCAN Health Plan New Mexico.