Instead of having deductions taken from your Social Security check to pay for Parts A and B, you may opt for Medicare Part C. It includes everything in Part A and Part B. It also offers coverage that may take the form of:

• A health [no-lexicon]maintenance[/no-lexicon] organization,
• A preferred provider organization,
• A Medical Savings Account, or
• Other new type of health plan.

Medicare Part C is called Medicare Advantage (MA). It brings the cost-saving measures of managed care into the Medicare program. You may find a MA plan that is cheaper than the [no-lexicon]premiums [/no-lexicon]you pay now.

You can think of MA as your choice of health insurance plans, rather than as a government reimbursement plan.

Under MA, you have a choice of a number of basic types of health insurance programs. Medicare will pay that program for the coverage you would have had under original Medicare. These organizations will then be managing your access to health care providers.

Through MA, you have these options for managed care plans (known as coordinated care plans):

• Health Maintenance Organization (HMO) plans emphasize preventive care. They do not offer coverage for providers or facilities outside the HMO network. They generally require that you choose a primary care doctor. They usually offer drug benefits. One specific option within HMO plans are HMO Point-of Service (HMOPOS) plans. Like general HMO plans, HMOPOS plans offer a network of preferred providers. HMOPOS plans also offer coverage for providers or facilities outside the HMO network, but with reduced benefits. To see a network specialist, HMOPOS plans usually require you to get a referral from a network primary physician.
• Preferred Provider Organization (PPO) plans have bigger geographic access to network providers in a larger service area. They also provide access to care outside the PPO network, but with reduced benefits. PPO plans do not usually require a referral from a network primary care physician to visit network specialists. If you see an in-network specialist, your costs will usually be lower than if you see an out-of-network specialist. PPO plans may or may not offer drug benefits.
• Private Fee-For-Service (PFFS) plans allow you to visit any health care provider that accepts Medicare, accepts you as a patient, and agrees to your PFFS plan's payment terms. Some PFFS plans have a network of providers who have agreed to treat plan members. With those PFFS plans, you can still visit an out-of-network provider who agrees to treat you, but you may pay more. Some PFFS plans offer drug benefits. If yours does not, you can join another Medicare drug plan for coverage.

There are also other types of plans available that meet different patient needs. For example, Special Needs Plans (SNPs) are available for people with specific medical considerations, such as people who live in nursing homes or who have certain chronic conditions. Another option is a Medical Savings Account. With a MSA, money is deposited into a special account that you can use to pay your medical expenses.

If you sign up for a MA plan and decide you don’t like it, you can change plans. However, you may be locked in for a period of time. If so, you can go back to the original Medicare (Parts A and B).

Pros and Cons

Below are some of the pros and cons of Medicare C.

Pros

With Medicare Advantage, you receive Medicare covered services, but you usually pay much less in out-of-pocket costs. Your out-of-pocket costs in a Medicare Advantage Plan depend on a variety of factors. These include whether the plan:

• Charges a monthly premium,
• Requires any deductibles or coinsurance payments, or
• Charges for extra benefits

Medicare Advantage Plans may offer extra coverage. These could include:

• Vision,
• [no-lexicon]Hearing[/no-lexicon],
• Dental, and
• Health and wellness programs.

Most plans also include prescription drug coverage (Part D).

Cons

Medicare Advantage plans might have different rules for how you get services. For example, they might make you get a referral to see a specialist. For non-emergency care, they might require that you only go to doctors that belong to the plan.

Your services may not be covered if you go to a doctor that doesn’t belong to the plan. Or, depending on the type of Medicare coverage you have, your costs could be higher.

More information

Call 1-800-MEDICARE or visit the Medicare website. This could help you decide if you want Part C or to make plan choices.