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Q: How Do Medicare Advantage Plans Work?

Asked by Anonymous on October 12, 2017

Hal Levy October 12, 2017

Medicare Advantage, also known as Medicare Part C, operates more like traditional health insurance than Original Medicare (Medicare Part A & Part B).

Enrolling in Medicare Part C/Medicare Advantage

To enroll in Medicare Advantage, you’ll have to choose a plan and sign up through a broker or insurer. Medicare Part C is offered by multiple private insurance companies. You can’t join a Medicare Advantage plan until you enroll in Original Medicare. If you decide to enroll in Medicare Part C, it will replace your Original Medicare coverage.

Once you enroll in Medicare Advantage, you’ll only interact with your insurer and their provider network. However, you’ll continue paying for Original Medicare, which the federal government will use to reimburse your Medicare Advantage insurer. Fortunately, your plan will help you consolidate these bills.

How Medicare Part C Works

Medicare Advantage plans work to cover all Original Medicare services and may offer additional benefits. Unlike Medicare Supplement plans, which are standardized no matter who sells them, private insurers can choose what their Part C plans offer. Insurers may define their own premiums, deductibles, copayments, and physician referral systems. Your Medicare Advantage plan will negotiate payments to doctors that may be higher than what they receive from Original Medicare. However, fewer doctors will be enrolled in your Medicare Advantage plan compared to Original Medicare.

Billing and Costs

Once you sign up for Part C, your billing and care may be consolidated. You can typically access all your medical services with just one card, choose a primary care physician, and pay for different treatments with a single bill.

The average Part C plan cost $31.40 per month in 2017. For a small additional premium, many Medicare Advantage plans cover prescription drug costs (replacing Medicare Part D coverage). Most Part C carriers have a zero-premium plan available, with higher copayments or fewer additional benefits.

Taking the Next Steps

You only need to enroll in Part C one time. We recommend visiting our Medicare Advantage comparison tool, or asking us to connect you with a local broker who can offer a free, no-obligation quote.

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