Medicare C Advantage Plans by Mary Jane Stern

Medicare has a good website and you can review all of the plans in your area, and that's just how I started. I spent hours researching the different Medicare C Advantage plans in Florida.  Advantage Plans must offer everything in Medicare Parts A and B and they offer three types of plans.

• A coordinated care plan (HMO, PPO)
• A combination plan that includes a medical savings account and a contribution into a medical savings account
• A Private Fee-For-Service Plan

These plans sometimes offer more coverage than Original Medicare, however --

• Some plans have an extra premium in addition to the Part B premium
• Limitations on providers and you must use in-network doctors and/or facilities 
• If you enroll in a Medicare Advantage plan that does not include Medicare Part D, you must enroll in a stand-alone Part D plan or you will not have Medicare drug coverage.

Before You Make Your Decision Review The Complete Plan Details

IMPORTANT -- if you are considering a Medicare C Advantage plan go to the individual website of the private insurer and get complete plan details before you enroll.  Here are a few things to look for:

• What doctors are in the plan?
• How much are the co-pays?
• Is there an additional premium along with the Part B premium?
• Do you have to pay higher co-pays for a specialist (e.g., cardiologist)?
• Can you go out of network without being penalized?
• What are the maximum out-of-pocket expenses per year?
• Do they pay for the first 3 pints of blood?
• What type of hospital co-pays are there?
• How many days do they pay for skilled care?

When You Sign Up For Medicare C Advantage Plan You Are Out Of Original Medicare

Well I thought we had found the perfect Medicare C Advantage plan that would help in case of a major problem, along with a standalone Part D plan.  Was I ever wrong and disappointed! 

Seems there's a little clause written into the law regarding participation in Part D (and remember the Advantage Plans and Part D Plans were written by insurance companies and pharmaceutical companies).

Here's What Medicare States:

Individuals who are enrolled in a Medicare Advantage plan established under Medicare Part C must receive their drug coverage through their Medicare Advantage prescription drug plan, known as an MA-PD.  They may not purchase a separate PDP (Prescription Drug Plan). However, individuals who are enrolled in a Medicare Advantage Private Fee-For-Service (PFFS) plan that does not include a prescription drug option may purchase a PDP for their Part D coverage.

Because prescriptions are a major part of my husband's healthcare we opted to say with Original Medicare and participate in plans A, B and D.  But each of us has a different health condition and what works for us doesn't mean it is right for you.