Though Medicare provides millions of Americans with excellent health benefits, it might not actually cover all the medical care you might need. To provide additional covered services, numerous private insurers offer Medicare Advantage plans, often called Medicare Part C coverage.

Medicare Advantage offers not only standard Medicare, but also other services. That’s extra care you won’t have to worry about paying for alone. 

What’s Medicare Advantage? 

Medicare Advantage plans are private plans offered by major insurance companies with the approval of the government. Think of Advantage plans as something of an enhanced version of Original Medicare, the U.S. government’s insurance program that began in the mid-20th century.

Original Medicare helps qualifying Americans, usually seniors or the disabled, get health insurance and medical care affordably. It offers two types of coverage:

• Medicare Part A covers costs related to inpatient medical care and surgeries. Nursing home stays, hospice, home health care, and related costs also have coverage under this section.

• Medicare Part B pays for medically-necessary services and routine medical care. Your regular checkup and related care usually have coverage under Part B.

Still, Original coverage does not pay for every type of care. That’s where Medicare Advantage can come into play. They can help you afford care that you might not be able to get with just Original coverage. 

Since Advantage Plans are "insurance company" plans, where Medicare is no longer primary or secondary, you will usually be required to stay within an insurance company's network of doctors and hospitals. It is very important to choose a plan with this in mind.

What is covered under Medicare Part C?

Though they are private plans, Medicare Advantage policies are highly-regulated. Policies must provide you with at least the benefits provided by Original Medicare Parts A & B.

Because these are private plans, any given Advantage plan varies in what additional services they will offer. Still, they often cover services like:

• Vision care

• Dental care

• Prescription drug costs

• Hearing aids and hearing tests

Advantage plans do not replace Original Medicare. You must remain in the Original program to remain eligible for Part C. Certain services, namely hospice care, will also still be covered by Original Medicare, rather than the Advantage plan. Still, your Part C plan will essentially take over for most Original Medicare services as long as you have the policy.

How do Medicare Advantage plans work?

Advantage plans come in many shapes and sizes such as:

• • • HMOs

    • PPOs

    • PFFS

    • Special-needs Plans (SNPs)

    • MSAs

You will essentially use your plan like you would any other health insurance. Policy rules will vary based on the plan you choose.

• • • You must pay a premium for your coverage.

    • Some policies will have deductibles or coinsurance costs.

    • You usually must see a doctor who accepts your plan.

    • Many Advantage plans include physician networks, which are groups of providers who will cost you the least money to see.

Why do I need Medicare Part C?

Think about how some of the additional Medicare Advantage services (such as dental or vision care) might benefit your health. Getting these services might mean a better wellness outlook for your future. You’ll have a lot more choice to get covered care when you need it most. 

Who qualifies for Medicare Advantage?

Medicare Advantage plans have their own enrollment rules. They usually require:

• You must have both Original Medicare Part A & Part B to qualify for to Medicare Advantage.

• You generally have to buy a policy offered in your area.

• You must be more than 65 years old to get a plan (some younger people can enroll, however).

• You cannot have end-stage renal disease (ESRD).

Plans vary widely, so talk to your Senior Healthcare Solutions agent to determine your unique eligibility.

When is Medicare Advantage enrollment?

There are several times each year when you can enroll in or change your Advantage plan. Most people enroll around their 65th birthday. We’re happy to explain the specifics of when you can buy, change or drop a plan. Check out the details about enrollment periods.

What is the average cost of Medicare Part C?

Your Advantage policy’s cost will vary based on numerous factors. You also might still have to pay your Original Medicare Part B premium in addition to the Part C premium. We can help you get covered affordably and ensure you are prepared for all your personal costs.

Who do You Call with Medicare Questions?

To get help with all your Medicare Part C questions, call Senior Healthcare Solutions MA at (508) 269-5291. We can help you get covered today!

You can also contact the Medicare system directly at:

www.Medicare.gov/forms-help-resources

National Phone Number: 1-800-MEDICARE (1-800-633-4227)

TTY Phone: 1-877-486-2048

Medicare Contact Center Operations

PO Box 1270, Lawrence, KS 66044

Medicare Part D: Helping Medicare Recipients Get Affordable Prescriptions

When you go to the doctor, you might present your Medicare card as proof that you have health insurance. However, if your doctor writes you a prescription, you can’t take your Original Medicare with you to the pharmacy and expect to get coverage. You’ll need Medicare Part D prescription insurance if you want coverage for your drug costs.

Medicare Part D prescription drug plans bridge the gap between Original Medicare and private benefits. If you get a plan, you’ll make your medications more affordable. Come to Senior Healthcare Solutions, and we’ll help you get the Medicare Part D plan that is of the most benefit to you. 

Medicare offers prescription drug coverage through private companies to everyone with Medicare. Even if you do not take prescription drugs you should still strongly consider joining a plan. If you decide not to join a plan and do not have credible prescription drug coverage you will likely pay a late enrollment penalty. 

What is Medicare Part D Prescription Coverage?

Original Medicare is the government’s tax-supported health insurance program for senior citizens and other qualifying individuals. The standard Original plan contains two types of coverage.

Medicare Part A will cover hospital costs, like inpatient stays, surgeries and related treatments.

However, where you won’t have coverage on Original coverage is at your pharmacy. Still, millions of people rely on prescription medication to maintain their health. To get coverage for these costs, you will have to get Medicare Part D prescription coverage. With coverage, rather than paying for what might amount to hundreds of dollars in medication costs, you’ll generally only pay a small cost out of pocket.  

There are two ways to get Medicare prescription drug coverage:

1) Medicare Prescription Drug Plans - These plans sometimes called PDP's add drug coverage to Original Medicare.

2) Medicare Advantage Plans - These plans such as HMOs and PPOs usually have a prescription plan included in them for no additional cost

If you have employer or union coverage, call your benefits administrator before you make any changes or sign up for coverage. If you drop union or employer coverage you may not be able to get back in. Also if the employee drops their coverage his spouse or family might loose theirs. So proceed cautiously.

How Does Your Coverage Work?

Medicare Part D plans are private plans offered by major insurance companies. They have their own premiums and cost structures. So, when you go to get a prescription filled, you’ll have to verify the exact personal cost.  You might have to pay the:

Part D Premium: This is the cost you pay for your plan in general.

With all Medicare drug plans you might enter a temporary coverage gap called the Medicare Donut Hole. When you enter this hole, you’ll pay more for your drugs for a time. You’ll enter the hole after you and your plan have paid a combined $3,820 (2019) for drugs that plan year. You’ll remain in the hole until you pay a total of $5,100 (2019). You’ll then exit the hole and your plan will then resume paying for most of your costs. 

There are 20 different PDP plans offered in New York. Each has a preferred pharmacy network and each has a different formulary of drugs. This task should be undertaken by a Medicare professional to insure the best fit. Premiums range from $16 - $91 per month.

What Will My Plan Look Like?

All Part D plans will vary in how they cover different medications. 

Most contain elements like:

• The Formulary: This is a list of Medications that the plan will cover. Covered drugs might vary by plan.

• Tiers: Different plans separate drugs into categories called tiers. The costs you pay will vary based on the tier of coverage. Usually, generic drugs will fall into the lowest tiers and cost the least. Drugs in the highest tiers are usually specialty or brand-name drugs that usually cost the most.

Drugs not within your plan’s formulary will not have coverage under your policy. Therefore, talk to your doctor about whether your plan will provide help. Our agents can also help you determine the right course of action.

Who qualifies for Medicare Part D?

If you qualify for Original Medicare, you’ll qualify for a Part D plan. Eligible parties include:

People aged 65 or older

Keep in mind, you’ll have to get a plan that is offered in your area. To have the full benefit of your coverage, you’ll need a localized plan.

Most people enroll in Part D coverage: During their initial enrollment period (IEP) for Part A & B coverage. For senior citizens, this is the 7-month period around your 65th birthday when you first become eligible for Original Medicare.

Critical Factors to Consider When Choosing a Plan:

• Plan Formulary (Are my drugs covered?)

• Preferred or non preferred drugs

• Preferred or standard pharmacies

• Premiums/ copays/ deductibles

Who do You Call with Medicare Questions?

To get help with all your Medicare Part D questions, call Senior Healthcare Solutions MA at (508) 269-5291. We can help you get covered today!

You can also contact the Medicare system directly at:

www.Medicare.gov/forms-help-resources

National Phone Number: 1-800-MEDICARE (1-800-633-4227)

TTY Phone: 1-877-486-2048

Medicare Contact Center Operations

PO Box 1270, Lawrence, KS 66044