Medicare Advantage (Part C)
Medicare recipients often find that Medicare's original plans do not offer all of the coverage they want or need. With Medicare Advantage plans, Medicare beneficiaries are offered the choice to get their Medicare through private companies which include additional benefits. Parts A and B of your standard Medicare plan cover hospital care and then medical, respectively, but it is possible that for you, your medical needs require a bit more coverage than that.
If you looked at the coverage benefits for Original Medicare and were disappointed to find dental, vision, or other needs were not included in Parts A or B, then a Medicare Advantage (Part C) plan might be precisely what the doctor ordered.
What Do I Need in Order to Be Eligible for Medicare Advantage (Part C)?
Generally, there are no health qualifications for Medicare Advantage (Part C) because they are offered to most recipients that already have Medicare Parts A and B. To qualify for Medicare, you need only have lived as a permanent resident in your state for at least five years, be 65 years of age or older (or, if younger, you receive disability benefits, have Lou Gehrig's disease, or end-stage renal failure).
The qualifying for Medicare Advantage (Part C) include:
- Being enrolled Medicare Parts A and B,
- Living in an Advantage plan's service area,
- Not having end-stage renal disease. You can talk to a Medicare broker to explore your options and try to find programs that make exceptions, however.
What Types of Medicare Advantage (Part C) Plans Are There?
Private insurance companies offer a range of different Medicare Advantage (Part C) plans to suit a variety of needs.
These can include:
- HMO, or Health Maintenance Organization Plans. Healthcare comes through a network of providers and hospitals, and these require a primary care physician.
- PPO, or Preferred Provider Organization Plans. More flexible than HMO, your costs are typically lower if you stay within your provider network, but you can go outside of the doctor network for a higher copay, and you don't need referrals or a primary care physician.
- SNP, or Special Needs Plans. These are for people with chronic conditions, that have both Medicare and Medicaid, or that live in institutions. Usually, they are tailored to your given situation. So a recipient with a chronic condition would have a plan with benefits that are specific to their needs.
With a Medicare Advantage plan you get all your Medicare through a private insurance company. Therefore you have one card that you show at the doctor, hospital, and pharmacy. Although you are still enrolled in Medicare you do not show your Original Medicare card and any bills should be paid by the Medicare Advantage (Part C) card and not Medicare through the government.
Medicare Advantage plans have to offer what Medicare has or better. These may have a copay for various healthcare services and the plans cost sharing varies based on the plan. Each county offers different plans.
What should you know before enrolling in a Medicare Advantage (Part C) plan?
- Does your doctor/hospital accept this plan?
- As stated above Medicare Advantage plans are typically HMO or PPO and therefore the doctors and hospitals you want to utilize should be in network.
- What is the cost sharing for healthcare and monthly premium of the plan?
- Each plan has a monthly fee along with copays/coinsurance for healthcare services. Make sure you shop the plans available in your area to find the plan that offers the lowest out of pocket costs for the services you may need.
- What price are your medications covered at?
- Medicare Advantage plans typically include prescription drug coverage and each plan categorizes the medications into tiers. The tier your medication is in relates to the cost you have to pay for that medication. Plans can also have deductibles for medications. Make sure your medication is covered in the plans formulary (list of medications the plan covers) and at what cost.
- What is the star rating of the Medicare Advantage plan?
- The Center for Medicare and Medicaid Services has a star rating system which is based on a number of categories including how members rate the plan. Plans fall between 0 and 5 star rating with 5 star being the highest.
You may find one or all of these types of Medicare Advantage (Part C) plans in your area. Consult with an agent in New Jersey Medicare Brokers for free to narrow your options to one that's right for you. These experts are dedicated to helping Medicare recipients to navigate the sea of options available with unbiased expertise.
- What are my dental insurance options while on Medicare?
- 2024 Changes to the NJ PAAD and Senior Gold programs: GSK and Eli Lily Participation
- Medicare and Social Security updates for 2024
- 2024 Medicare Enrollment Period
- Medicare Announces Price Negotiations on 10 Prescriptions
- New and Expanded state assistance programs for Seniors in New Jersey - NJ PAAD, Senior Gold, NJ Freeze & Stay NJ
- Supporting a loved one on Medicare in New Jersey
- Five reasons to work with a Medicare Insurance Broker in New Jersey
- NJ FamilyCare, PAAD, and Senior Gold Renewal- Post COVID-19 Emergency Declaration
- 6 Ways to Prepare for Medicare if You’re Working Past 65
- Medicare updates for 2023!
- Medicare Annual Election Period ends 12/7 and NJ State Assistance thresholds have updated for 2023!
- Medicare Advantage Versus Medicare Supplement – What’s the difference?
- Shingles vaccines are $0 in 2023 thanks to the Inflation Reduction Act!
- Medicare Premium is Going Down in 2023! Medicare Annual Enrollment Period is here!
- Protecting Yourself Against Medicare Scams
- Medicare changes when moving to or from New Jersey
- Medicare Premium Payment Options
- NJ PAAD and Senior Gold raised their qualifications by $10,000 in 2022!
- The Medicare Advertisements should stop after December 7th!
- Medicare Open Enrollment Period Continues Until December 7th
- 2022 Medicare Open Enrollment Period
- What will you be billed for a hospital stay with Medicare coverage?
- Understanding Medicare and IRMAA - Income Related Monthly Adjustment Amount
- Does Medicare Cover Gym Membership?
- Are you insured when traveling with Medicare?
- Medicare and Dental
- What to Know when you Qualify for Medicare due to Disability in New Jersey
- What to Know About Medicare and COBRA
- What to Know About Visiting a New Jersey Social Security / Medicare Office
- Options for New Jersey Prescription Help
- How Important is the Medicare Star Rating?
- Medicare Assignment
- Why Should You Engage with a Medicare Broker?
- President Biden’s Medicare Plan
- A Guide to Medicare HMO and PPO Options
- Medicare Part D Senior Savings Model: An Overview
- Do You Need Help with Medicare.gov?
- Medicare and Acupuncture
- Medicare vs Medicaid: What's the Difference?
- What to Do When Helping Parents with Medicare
- Understanding the Medicare Plans in NJ
- Medicare and Coronavirus
- Delaying Medicare Part B
- Finding Medicare Assistance
- How Do I Sign Up for Medicare Part B in New Jersey?
- Medicare Help—Making Medicare Easy
- PAAD: New Jersey's Prescription Assistance Program
- Medicare Insurance Agents and Brokers
- Finding Your NJ Medicare Broker
- Medicare Part D Eligibility
- Medicare Advantage (Part C)
- New Jersey's Dual-Eligible Special Needs Plans - The Facts
- Medicare Eligibilty Age
- Medicare through Social Security Disability in New Jersey - You Don't Just Age into the System
- New Jersey Senior Gold Assistance Program- What You Need to Know
- Assistance Programs in New Jersey for Medicare Eligibles
- Top 7 Medicare Mistakes
- Utilizing Your New Jersey Medicare Insurance Agent
- Medicare and High Income: Does Income Change the Cost of Medicare?
- Changing Medigap Plans
- Why Am I Getting A Bill For a Medicare Physical Exam
- How Medicare Brokers Can Help
- Republican Plans for Medicare in 2020
- What You Need to Know About Medicare in New Jersey
- NJ PAAD Application Help
- What Really Is Medicare for All?