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Part C of Medicare (Advantage Plans)

A Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D. Medicare Advantage plans are not considered supplemental Medicare coverage. These plans must provide the same benefits as Original Medicare (those covered under Parts A and B); however, each plan can charge different out-of-pocket costs and have different rules for getting services. If you enroll in an Advantage Plan, you must continue to pay the Medicare Part B premium of $174.70.

Medicare Advantage or Disadvantage?

You leave Medicare, and your primary coverage is with an insurance company. Advantage Plans have networks (HMO or PPO), so the doctors and hospitals you can see will be limited. If you want to go to a doctor or hospital not in the plan’s network, you’d have to pay all or a significant portion of the cost. When you travel, you are out of network. Advantage Plans are managed care plans that require pre-authorization for many medical services and treatments, which could mean delay or denial of medical care.

The plan can dictate which doctors you see and what treatments you can get. You can think of Medicare Advantage plans as “pay as you go.” The more you use the plan the higher your out-of-pocket costs will be. You could face substantial out-of-pocket costs with an Advantage Plan, as much as $8,300 in a calendar year. Some plans set lower limits.

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