2104 SW 152nd St, Suite 2, Burien, WA 98166

(206) 466-1935

(206) 258-4670

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Part C

A Medicare Advantage Plan is a Medicare insurance plan choice you may have in addition to Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by CMS, which stands for the Centers of Medicare and Medicaid Services.

If you join a Medicare Advantage Plan, the insurance plan will provide all of your Original Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer or include extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Part D (Prescription Drug Coverage).

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist). These rules can change each year. There are only certain times during the year that you can enroll in a Medicare Advantage Plan.

MEDICARE PART C ELIGIBILITY:

  • Must be enrolled in Medicare Part A and Part B

  • Must continue to pay the Part B premium

  • Have to permanently reside within the plans service area (usually based on the county of your permanent address)

  • You cannot have End Stage Renal Disease as a pre-existing condition

MEDICARE PART C PREMIUMS:

  • Beneficiary continues to pay Part B premium

  • Medicare Advantage (MA) monthly plan premium

  • Many MA plans offer a zero monthly premium plan

MEDICARE ADVANTAGE PLAN TYPES

There are different types of Medicare Advantage plans – each bear different rules for coverage. We will work with you to find the type that will fit your needs the best.

HMO PLANS = HEALTH MAINTENANCE ORGANIZATION

  • Members must only use in-network plan providers, except during an emergency or urgent care situations.

  • Your Primary Care Provider oversees your care and refers you to specialists. Specialist visits will not be covered by the insurance company unless you have been referred by your Primary Care Physician. This is considered a “Managed Care Plan”.

PPO PLANS = PREFERRED PROVIDER ORGANIZATION

  • Care is provided through a network of doctors, hospitals and other health care professionals.

  • You do not need a referral to see a specialist and you can go out of network for any covered services if the care is provided by a physician who is contracted with Medicare.

  • Some benefits may be at a higher cost when care is given by an out-of-network provider.

HMO/POS = HMO POINT OF SERVICE PLAN

  • This is a type of HMO plan that provides care through a network of local doctors and hospitals, but lets you receive certain services outside the plan’s network, generally at a higher cost.

SNP PLANS = SPECIAL NEEDS PLAN:

These plans are designed for:

  • Residents of nursing homes

  • People eligible for both Medicare and Medicaid benefits

  • People with certain chronic diseases such as diabetes or heart disease

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