There is original Medicare Part A (hospital) and Part B (medical insurance). Do you know about Medicare Part C or Medicare Advantage? It is another way for people eligible for Medicare to receive their healthcare coverage. They are not for everybody however they make up about half the Medicare Enrollments.
 They are plans offered by private insurance companies approved by Medicare. These plans are not available in every county of Washington state. Every year, we undergo rigorous training by the Centers for Medicare & Medicaid Services and the insurance companies to understand the rules better. They are required by law to cover all medically necessary services that original medicare covers.
One way to look at it is the original Medicare is a General Contractor. The Medicare Advantage company acts like a subcontractor. When you select one of those MA plans original Medicare moves to the background and the Medicare Advantage plan takes care of the healthcare instead.
Here are some key points about Medicare Part C:
Comprehensive Coverage: Medicare Advantage plans typically bundle Part A, Part B, and often Part D (prescription drug) coverages. They may also offer additional benefits not covered by Original Medicare, such as hearing, vision, and dental.
Network Restrictions: These plans usually have network restrictions, meaning you may need to use healthcare providers who are part of the plan’s network. These are often Health Maintenance Organizations or HMO networks. Some plans also have Point of Service plans which benefit clients who travel. Reviewing networks is an important part of the Annual Enrollment Period!
Out-of-Pocket Costs: While Medicare Advantage plans can have lower premium costs, they may have different out-of-pocket costs compared to Original Medicare. They usually have co-pays for services like a traditional healthcare plan.
Additional Benefits: Many plans offer extras such as gym memberships or fitness clubs, transportation to medical appointments, and wellness programs. These are incentives or perks on top of the medical coverage that can be very attractive to clients.
Annual Enrollment: Beneficiaries can choose or switch Medicare Advantage plans during the annual enrollment periods.
From October 1st to October 14th is the review period where you can see the changes for the upcoming enrollment year.
October 15th through December 7th is the Annual Enrollment Period. This allows you to review and make changes to your Medicare plans.
Medicare Advantage plans vary greatly in terms of costs, benefits, and restrictions, so clients should compare different plans to find one that best meets their health needs.
Suzie McColm at Wenatchee Insurance has been assisting people to understand and select plans for over ten years. She also has held a pharmacy technician’s license for over twenty years which is valuable in understanding the prescription side of coverage.
