Part C: Medicare Advantage
Medicare Part C is also known as Medicare Advantage. There are Medicare Advantage plans, and there are Medicare Advantage Prescription Drug plans.
Both are Part C, and depending on what part of the country you live in, you may only have
access to a MA plan and have to get separate prescription drug coverage.
**I live in Los Angeles County and we have really amazing plans which offer prescription drug coverage. So I only deal with MAPD, and all my references will be to MAPD plans that are
currently available in Los Angeles County.**
Part C is relatively new and was introduced during Bill Clinton’s time in the White House. It is meant to give Medicare beneficiaries a lower
premium option compared to a Medigap plan.
What is Medigap?
Medigap is different from Medicare Advantage. Medigap sometimes is called a Medicare Supplement.
People use the wrong terms all the time, but this is what you need to know. A Medigap plan is private insurance by an insurance company like (United, Aetna, Humana, etc). It was meant to help cover the costs that members incur when only having Uncle Sam’s Original plan, Parts A and B of Medicare.
Medigap plans are the ones that are named after alphabet letters, and this is what leads to confusing most people.
(Ex: Plan K, Plan F, Plan G, Plan G High Deductible, Plan N, yada, yada, yada).
Since I live in a county with MAPD plans that have greater benefits than supplement plans, I’m not going to address them because for the people I serve, MAPD is the best choice.
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The best time to enroll in a MAPD is during your Initial Enrollment Period. Which if you recall in Medicare Overview, is 7 months out of the year in which you turn age 65. After that initial period, you then have certain designated times throughout the year where you can switch and enroll in a MAPD. If you enroll into a 5 Star plan or a Special Needs Plan, you can enroll almost ANYTIME of the year.
Some things to note for MAPD are the following:
- Must be enrolled in Medicare Part A and B at all times to remain in a MAPD.
- Have to use/stay in network. If you go out of network, higher costs will be assessed.
- Certain procedures and prescriptions may require a prior authorization from your primary doctor.
- You may need to obtain a referral from your primary care physician before seeing a specialist.
- MAPD can change from year to year in regards to doctors in the network as well as drugs covered and cost.
- If you enroll in a MAPD at age 65 you may be putting yourself in jeopardy if you ever decide to get a Medigap (Med Supp).
Last thing to mention about MAPD plans, are the EXTRA BENEFITS! I put that in bold, because these are the reasons most people enroll in a MAPD. They want the bennies.
Each carrier will have multiple plans available in a county and each plan will offer different benefits. So, it is best to contact us so we can go over your options with you if you are confused as to which plan is best for you.
A sample list of MAPD benefits:
- No cost dental
- X- rays
- No cost hearing
- $2000+ per year to offset the cost of hearing aides
- FREE transportation to medical appointments
- In home health care
- $50 monthly utility stipend
- No cost vision
- $200-$800 for eyeglasses or contacts
- Part B Giveback
- Money directly put back into your Social Security check to offset the monthly Medicare Part B premium amount
- No cost gym/fitness membership
- CVS over the counter medical supply (over $1200 per year)
- 24/7 teledoc and nurse line
- Plus much more!