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Medicare Part C

Medicare Advantage Plans

Medicare Part C refers to Medicare health plans or ‘Medicare Advantage’ plans (formerly known as Medicare Choice+ Plans) offered by Medicare-approved private companies that must follow rules set by Medicare. These plans incorporate your Medicare Part A, Medicare Part B, and often Medicare Part D – Prescription Drug coverage – into one plan. Private insurance companies contract with Medicare to offer Medicare Advantage (MA) plans. If you enroll in a Medicare Advantage plan, you still have Medicare – however the insurance company pays your claims, not Medicare. Medicare pays a private insurance company to provide your healthcare coverage with a Medicare Advantage plan. These plans must, at minimum, provide the same

level of coverage as Original Medicare (Part A and Part B). Medicare Advantage plans often include additional benefits not offered by Original Medicare.

Important MA Plan Facts

  • You must have enrolled in Part A & Part B and continue to pay the Part B premium.
  • You must reside in the service area of the plan you select.
  • You may not have a Medicare Advantage plan and a Medicare Supplement insurance plan at the same time.
  • You can only join or leave a Medicare Advantage plan at certain times during the year.
  • Insurance companies sponsoring Medicare Advantage plans are paid directly by Medicare to assume full responsibility for your health care.
  • Medicare Advantage plans out-of-pocket costs vary—plans may have lower or higher out-of-pocket costs for certain Medicare-approved services.
  • Medicare Advantage plans cannot adjust what they charge based on the member’s age, health, or claims experience.
  • Medicare Advantage plans are closely monitored, and each plan must be approved annually by the Centers for Medicare & Medicaid Services (CMS) before being marketed during the Medicare Annual Enrollment Period (AEP).

Understanding Medicare Advantage Plans

  • In most cases, you’ll need to use healthcare providers who participate in the plan’s network. Some plans offer out-of-network coverage but out-of-pocket costs vary.
  • Medicare Advantage plans may have lower or higher out-of-pocket costs for certain services.
  • People who already have a Medicare Advantage plan will receive an “Annual Notice of Coverage” (ANOC) letter and an “Evidence of Coverage” (EOC) letter from their Medicare Advantage plan before the start of the Medicare Annual Enrollment Period (AEP). Medicare Advantage members are strongly encouraged to carefully review these letters
    • The ANOC letter: Includes any changes in coverage, costs, service area, and more that will be effective starting in January. Your plan will send you a printed copy by September 30.
    • The EOC Letter: Gives you details about what the plan covers, how much you pay, and more. Your plan will send you a notice (or printed copy) by October 15, which will include information on how to access the EOC electronically or request a printed copy.

Most healthcare providers only accept a limited number of Medicare Advantage plans, so patients are strongly encouraged to confirm which Medicare Advantage plans their healthcare providers accept before applying for coverage. It seems awfully confusing but we can help you navigate through this maze and that too without any cost or obligation. Just call 904-575-5450 to consult with a licensed agent trained in Medicare plans. You can also fill out the contact form or send email to info@getmedicare.com and we will reach back ou to you.