Medicare Part C – Medicare Advantage

In 1986 Medicare began experimenting with cost saving alternatives to the Original Medicare Program. In 1997 the first of these such plans were launched and were originally marketed under the term “Medicare Replacement Plans”. After undergoing several name changes, these plans today are called “Medicare Advantage Plans”. However, the original name is still more descriptive than the name used today.

A Medicare Advantage Plan is a health plan offered by private companies. These plans administer your health coverage instead of Original Medicare. These plans cover health care costs in a variety of ways but are mandated by law to provide coverage at least as good as the Original Medicare program. They may also, at their discretion, add coverage for items or services not typically covered by Original Medicare.

Medicare Advantage Plans are sold in three main organizational types.

  • HMO: these plans utilize a gatekeeper physician to help manage your care and a strict provider network.
  • PPO: these plans do not utilize a gatekeeper physician and allow you to see providers outside of the provider network at a higher copay.
  • PFFS: these plans do not utilize a gatekeeper physician and may or may not have a provider network. In cases where there is no provider network, a provider must agree to the terms and conditions of the plan before treating you.

Medicare Advantage Plans can vary greatly in design (see above), cost ($0-302/month), coverage (with and without drug coverage), and availability (not available in every county). Since there is so much variety in plan types and benefits, we encourage you if you have questions about these types of plans to call or email us and we can discuss in detail the plans available in your area.

doctor speaking to 2 elderly people