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Medicare Advantage - Part C of Medicare


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Up until 2006, this coverage option was referred to as “Medicare+Choice” or  Medicare “HMOs.” 
     Part C  Includes:  

  • HMO-(Health Maintenance Organization,)    
  • HMO/POS-(Health Maintenance Organization with Point-Of-Service option,)  
  • PPO-(Preferred Provider Organization,) and 
  • PFFS-(Private Fee For Service) PFFS plans are not available in all areas.

Medicare Advantage-MA plans are offered by private companies that contract with Medicare to provide all Part A and Part B benefits.

Plans contain Co-Pays  and/or  Deductible that the member is required to pay to obtain most Medical, Hospital & other covered services.  Always review the plan’s Summary of Benefits before you enroll.

MA Providers offer full medical plans with, and without, “Part D” prescription drug coverage.

Some plans offer additional benefits, or options, that “original Medicare” does not offer, such as;    Vision care, Preventative health services, Hearing Aids, Dental, Fitness Club membership, etc. 

Part C Premiums vary by Provider, Plan and Area.  You are still required to pay the Part B premium, and usually a monthly premium to the Plan provider, although there are a few “Zero” premium plans.

Other Considerations between Medicare Plan Choices…

Original Medicare - Parts A & B

Medicare Advantage - Part C

  • Greatest Freedom to Choose Doctors, Facilities and Medical Care.
  • Typically, higher monthly premium costs. 
  • Providers and Physicians work for you, not the health care provider. 
  • Better selection of Part D Prescription plans.  
  • California Open Enrollment allows you to change Medigap coverage every year, even with serious health conditions. 
  • Benefits are more stable & Medigap plans are Guaranteed Renewable for Life.
 
  • HMO- Must go to chosen HMO “PCP” (Primary Care Physician) & follow HMO guidelines for care. 
  • PPOs offer more choice of Doctors than HMO. 
  • May offer certain benefits in addition to Original Medicare’s Part A & B coverage. 
  • Low monthly & zero premium plans are available. 
  • Provider/Plan determines your drug coverage. 
  • May not be able to obtain MediGap plan later if you have certain health/medical conditions. 
  • Plans can change substantially, or even can be discontinued, each year. 
 
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