Advantage Plans (Part C) with Premiums Starting at $0/Month

For you to be able to consider joining a Advantage plan you need to already have Medicare Parts A & B, you must live in a plans service area & you can NOT have End Stage Renal Disease

MA plans are a viable choice for many people who don’t want to pay for a Medigap plan. Yes, you will have some restrictions and out of pocket costs but we can simply compare each option

Let's go over some of the basics first...

Medicare Advantage Part C is health insurance offered by private insurance companies that are contracted by Medicare. If you decide to join an Advantage plan, you will get all the services you are eligible for under Original Medicare. In addition, some plans offer care NOT covered by Original Medicare. These may include dental, vision, and hearing care for example. Next, let’s look at the most common types of Medicare Advantage Plans.

HMO

If you join an HMO (Health Maintenance Organization), you will have a primary care doctor (PCP) who will coordinate all your care. If you need a specialist, your PCP will need to write you a referral. HMO’s have networks, which means you have to use providers and facilities inside that network. 

PPO

A PPO (Preferred Provider Organization) is almost the same as an HMO, the main difference is that a PPO gives you a larger network of providers and the option to go outside of your network. In exchange, you will have to pay larger copays when using providers who are not in the network.  

SNP

SNP’s are Special Needs Plans for people who have certain conditions like Diabetes. There are also Dual SNP’s, which are for people who have Medicare but also qualify for Medicaid at the same time. SNP’s work on the basis of more closely coordinating care with the beneficiaries to provider care. 

What you will have to pay

Once you are enrolled, you will have costs associated with your care. Let’s look at some examples (Your plan might have different amounts)

HMO

Here is a partial out-of-pocket breakdown of a 2020 HMO plan in the Tampa Area that a lot of people signed up for. 

  • Premium $0
  • PCP Visit = $0
  • Specialist = $5
  • Hospital = $25 Day 1-6
  • ER Visit = $ 100
  • MOOP = $1900
  • RX Inc – No Deductible
  • Vision, Dental, Hearing, OTC & Fitness + more Included 

PPO

Here is a partial out-of-pocket breakdown of a 2020 Regional PPO. That means you can visit certain providers state-wide.

  • Premium $101
  • PCP = $5
  • Specialist = $45
  • Hospital = $290 Day 1-6
  • MOOP = $6700
  • RX Inc – $100 Ded T1-5
  • Vision, Dental, Hearing, OTC & Fitness + more Included

D-SNP

Dual Eligible Special Needs plans are for people who also qualify for Medicaid. These plans include rich supplemental benefits designed for dual members.

  I’m not going to go into that here, it’s different for everyone because it’s based on what you qualify for. If you have Medicare & Medicaid, we can review your coverage to make sure that you are getting everything you’re supposed to.

What you need to consider with Part C

Medicare Advantage plans work great for some people, but others hate them due to their restrictions. You need to look at all options to decide which one works best for your health & future health. 

If you have any questions, we are here to help you answer them. You can call us directly @ 727-777-3661 or schedule your appointment below. 

Medicare Advantage plans are widely used in the United States.

As of 2019, 34% of people who have Medicare are enrolled.

The good, the bad & the ugly!

The most comprehensive coverage, which will likely result in the fewest unexpected out-of-pocket expenses, is traditional Medicare Part A&B paired with a Medigap plan.

Most people who have their Medicare structured like that don’t have surprises that they can’t handle.

Over the last 10 years, Advantage companies have made a big push to the market Part C plans to the masses. Sometimes with great results to those who find the right plan but it can have great consequences to those who simply fall for enticing marketing that says it’s all $0!

It is very important to sit down with someone who knows these plans and can answer all your questions so that you don’t have any surprises in the future.