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Is Medicare Part C The Same As Medicare Advantage?

by David Bynon, last updated

Medicare Advantage is Medicare Part C, the private health plan option for people with Medicare Part A and Part B benefits. They are the same.

Medicare Part C was branded Medicare Advantage by the federal government to help distinguish it from traditional Medicare. Whether or not it is an advantage depends on the plans available in your area, your health, and your financial situation.

What is Medicare Advantage?

Medicare Part C is a private health insurance option for people on Medicare. It was added to the program to save money – for both the federal government and plan members – and to give people with Medicare more options.

What Does Medicare Advantage Cover?

All of a Medicare beneficiary’s health insurance benefits carryover if they join a Medicare Advantage plan. Nothing is lost.

That means all of the inpatient care benefits contained in Medicare Part A and the medical insurance (outpatient) benefits in Medicare Part B must be covered by Medicare Advantage plans. What is different is how plans cover Part A and Part B benefits and what they can charge members when they use their benefits.

What Do Medicare Advantage Plans Cover as Compared to Original Medicare?

From its inception, Original Medicare was only designed to cover medically necessary healthcare services. Over the years, the Medicare program has added wellness benefits, including certain vaccinations, tests, and an annual wellness visit. All of these benefits are included in Medicare Advantage plans, too.

Where Medicare Advantage plans differ is in their ability to include additional benefits. This includes benefits that Medicare does not consider medically necessary and are not Medicare-approved.

Although not a coverage difference per se, Original Medicare does not require referrals or pre-authorization to see a specialist. Most Medicare Advantage plans do. For many people, authorizations and referrals are the key difference between Medicare Part B and Part C.

How Does Medicare Advantage Compare with Medicare Supplement Insurance?

Medicare Supplements work with Original Medicare to help pay some of the costs Medicare doesn’t pay. That’s why Medicare calls it Medigap insurance. It fills in the out-of-pocket costs. What they can’t do is offer extra benefits.

For example, Part B covers medications https://medicarewire.com/wp-content/uploads/2024/06/Geisinger-logo-1.svgistered by your doctor, like a vaccination, so a Medigap plan can cover that out-of-pocket cost. Part B doesn’t cover prescriptions you take at home, so a Medigap plan can’t cover them for you, either. The same is true with Part A’s hospital insurance costs and all other Medicare-approved doctor visits.

The equivalent to Medigap with Medicare Advantage is called the MOOP, or maximum out-of-pocket limit. Every plan has a MOOP. The MOOP limit changes every few years.

Generally speaking, the higher the monthly premium, the lower a plan’s MOOP will be. However, this is not always the case. In some competitive markets, even low-cost plans have a low MOOP. The exact opposite can happen in low-competition markets.

What Extra Benefits Can I Get From Medicare Advantage?

Since its inception, the Medicare Advantage program has continuously added allowable benefits. The core list of extra benefits has not changed much. It includes:

  • Prescription drug plans (Medicare Part D).
  • Routine vision, hearing (including hearing aids), and dental care.
  • Wellness and preventive care programs, including gym memberships.

Due to the pandemic, telehealth benefits are also very common.

Some other, less common additional benefits plans offer include:

  • Over-the-counter medications.
  • Transportation to and from doctor appointments.
  • Nutritional assistance, such as meal deliveries.
  • Non-traditional medicine, such as acupuncture.
  • Accessibility and safety benefits, such as wheelchair ramps and shower grab bars.
  • Financial benefits, such as a Part B premium rebate (giveback).

It’s important to mention that not all plans offer extra benefits. The most common additional benefit offered is prescription drug coverage (Part D plan).

NOTE: If you get a cold call with a Medicare plan offer that seems too good to be true, it might just be a Medicare Part C scam. Don’t fall for it.

How Much Does Medicare Advantage Cost?

There’s a common misconception that Medicare Advantage plans cost less than Original Medicare. Some plans even appear to be free.

Let’s dispel the myths with some facts.

Why Are Some Medicare Advantage Plans Free?

Medicare Advantage plans are not free.

When you see a Medicare Advantage plan that’s advertised for zero dollars, it means that that plan does not require an additional monthly premium. However, if you join the plan you are still required to pay your monthly Medicare Part B premium. And, if you are a high-income earner, you will also pay an Income Related Monthly Adjustment Amount (IRMAA).

Will Medicare Advantage Save Me Money?

Whether or not a Medicare Advantage plan will save you money or cost you more depends on the plan you choose and your use of healthcare services.

Every Medicare Advantage can have the following costs, cost-sharing, and limits:

  • A monthly premium;
  • An annual deductible on both the health plan and the drug plan (if included);
  • Out-of-pocket costs when services are used, including copayments and/or coinsurance; and
  • An annual maximum out-of-pocket (MOOP) limit.

All of the cost components, as well as your use of healthcare services, must be evaluated before you will know if a plan will potentially save you money. Let’s be honest, none of us know when we might be hospitalized or develop a chronic illness.

Are There Different Types of Medicare Advantage Plans?

Yes!

One of the best features of Medicare Advantage is the various types of insurance plans available. The most common types of plans offered in most areas are Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans. But you will also find HMO-POS (point of service) plans and Private Fee-for-Service (PFFS) plans in some markets.

Most health plans use provider networks to deliver Medicare coverage to their members. This is one of the ways private insurance is different than Original Medicare.

With Original Medicare, you can use any provider you want, anywhere in the USA, so long as they accept Medicare and agree to see you. When you choose private insurance, the insurance company has the right to require you to use their network or pay all costs yourself.

HMO plans and PPO plans differ slightly when it comes to network providers. For example, with a PPO plan, you can use healthcare providers outside of the plan’s network for covered services, but you will pay more than you would if you stay in-network.

NOTE: With all Medicare Advantage plans, you can go out-of-network for emergency medical care. However, plans do not cover foreign travel emergencies. For that, you will need Medicare Supplement insurance.

There’s a new type of private health plan that does not have a provider network. It’s a medical savings account (MSA) plan.

Do Medicare Advantage Plans Work With Medicaid?

Yep. They sure do!

If you qualify for both Medicare and Medicaid, be sure to check out the Special Needs Plans (SNPs) available in your service area. Where available, D-SNP plans help coordinate your benefits and cover most of your out-of-pocket costs, so your cost-sharing is minimal.

For dual-eligible people, Medicare Advantage SNP plans are a big advantage.

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