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Medicare Advantage (Part C)

Medicare Advantage Part C - Known as Managed Care Plans

Medicare Advantage - Part C ("Medicare & You"  pages 75-90)

In 1993 Medicare Part C was introduced.  It is the designation given to what is known as managed care plans. Examples of managed care plans are:

  • Health Maintenance Organizations (HMO) 
  • Preferred Provider Organizations (PPO). 
  • Private Fee-for-Service (PFFS)

With Medicare Advantage plans (Part C), private insurance companies are being paid by Medicare to take over the administration and payment of claims for you. While you still pay for Medicare Part B, Medicare is in the background. No claims are filed with Medicare, they make no claims payments and you do not appeal a claim denial for Medicare to pay. Everything goes through the private insurance company.

You may use any doctor or hospital that will accept your plan, but if the doctor is not in your network you may pay a higher out of pocket cost.  To be able to offer you a lower cost for your plan, these plans work with networks of doctors and hospitals.  In exchange for these restrictions, your premiums may be significantly lower than a standard supplement and may offer additional benefits. You will have co-pays for some or most medical services received up to an annual out-of-pocket limit.

Our role at Senior Connection is to help you compare ALL of the options you have available for coverage.  We will not take the position that a Medicare supplement is better than a Medicare Advantage plan or vice versa; but we will make sure you understand the difference between the two.

--Medicare and You booklet

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