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Medicare Part C, also known as "Medicare Advantage" is an alternative to coverage under Medicare Parts A and B. If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
You are eligible to switch to a Medicare Advantage plan, provided you reside in the plan's service area and are enrolled in Medicare Parts A and B. If you have Medicare and enroll in a Medicare Advantage plan you generally get all of your medical services through that plan.
Medicare Advantage attempts to incorporate the cost-saving measures of "managed care" in a new manner that may take the form of an health maintenance organization, preferred provider organization, health savings accounts or other new variations of traditional health plans.
Medicare Advantage managed care plans may have some out-of-pocket, but they do generally save some of the out-of-pocket costs traditionally associated with original Medicare Parts A and B. Like private insurance, you can choose from Health Maintenance Organizations (HMO's) and Preferred Provider Organizations (PPOs). These organizations contract with Medicare to provide Medicare benefits in a managed care setting. Private Fee for Service plans (PFFS) and Medical Savings Accounts (MSAs) can contract with Medicare to provide Part A and B benefits through an insurance program. Most plans do include a prescription drug benefit.
Medicare Advantage includes new incentives for healthcare organizations to participate in the Medicare managed care program and for beneficiaries to sign up for a private plan, while at the same time instituting bidding processes designed to help control the rising cost of the Medicare program. Organizations will be able to offer a wider variety of health plans. In addition, the now available plans can cater for special needs beneficiaries, those with particularly complex conditions that require many healthcare resources to treat. The reform of Medicare Part C is also designed to provide beneficiaries, especially in rural areas, with more choices of private plans.
Medicare Advantage health plans are reimbursed by the Centers for Medicare and Medicaid Services for each person who enrolls in their plan. Once enrolled in a Medicare Advantage health plan, there are generally no claims to file or bills to submit directly to Medicare since Medicare has already paid the Medicare Advantage health plan for your care.
Because of the fact that Medicare reimburses the Medicare Advantage health plan directly for each enrollee, the monthly premiums for such plans are either $0 or very low.
So, if you are entitled to Medicare Part A, which for most people is premium-free, and you are already are paying for Medicare Part B, it makes sense to at least explore a Medicare Advantage plan available in your area. Medicare Advantage plans are highly regional, they can offer a plan in one county, but not in the next county. You need to find out which plan's service your area.
Current Medicare Advantage options:
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B before you can get Part C. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.
Call 1-800-MEDICARE or visit http://www.medicare.gov/ to determine what your plan choices are in your area.
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