Get Ready for Medicare: Part C

Past coverage: Medicare Parts A & B

Medicare Parts A & B were covered in the Health column published in the August edition of Atlanta Senior Life. This month, we explore Medicare Part C. Watch for information on Medicare Part D in the October Atlanta Senior Life. To review information about Medicare Parts A & B, go to atlantaseniorlife.com

First question: Is it called Medicare Part C, or the Medicare Advantage Plan?

Answer: It’s both.

Medicare Advantage plans are sometimes referred to as Medicare Part C, according to Medicare.gov. “Part C includes Medicare-approved private health insurance plans for individuals who are enrolled in Original Medicare, Part A and Part B.”

When you join a Medicare Advantage plan, you remain in the Medicare program and must continue paying your Part B premiums, according to Medicare’s rules. By now, you might be thinking that Medicare is extremely complicated. It is.

“All health insurance is complicated and often opaque and impenetrable,” Phillip Moeller states in his book, “Get What’s Yours for Medicare: Maximize your coverage, Minimize Your Costs.”

Keep in mind that complex questions can usually be answered by Medicare specialists and insurance brokers.

Coverage and Prevention

While Medicare Parts A and B are programs operated and administered by the government, Medicare Part C may be privately administered under rules established by the government.

A Medicare Advantage plan includes all of your Part A (hospital insurance) and Part B coverage. And sometimes benefits include vision and dental checkups. In fact, some plans include hearing checkups, and they generally offer prescription medication coverage (or at least partial coverage).

One major difference between the plans is that Part C plans generally have specific networks, which mean you will see certain doctors and go to certain hospitals within the plan’s network to get your care. In some cases, it means leaving your previous physicians behind, or paying additional fees if seeing someone out of network.

For many, it is the bundling of coverage that creates the “advantage” for Medicare recipients.

For example, Blue Cross and Blue Shield of Georgia (BCBSGa) is committed to giving consumers “high quality and affordable” healthcare services by offering four types of plans.

“The BCBSGa Medicare Advantage plans vary in benefits, but some do include hearing, dental and eye exams,” said Blue Cross Public Relations Director Hieu Nguyen.

Benefits differ, too. Nguyen said one plan might offer 10 days of home-delivered meals after a hospital discharge, while another might have transportation services to health-related destinations. Still another might be designed for individuals eligible for both Medicare and Medicaid.

“I have found that my Kaiser Advantage plan is all about prevention,” said Trisha Sinnott, director and founder of Pathway Tours in Atlanta. “I was delighted to learn that Kaiser covers healthcare when I am overseas. I recently lived in London for six months and was confident that if I had needed healthcare, I would be covered,” she said. “I also liked that Kaiser advised and provided me with most of the medications and immunizations I might need for travel to several Asian countries.”

Shirley Slaton, an Atlanta native in her early 70s, also likes her Medicare Advantage Plan with Kaiser. “They really take care of seniors,” she said.

Her out-of-pocket expenses are minimal, she says. “I spend around $2 to $3 dollars when I pick up three months of medications,” Slaton said. Both women talked about the convenience of going to one location for their lab, screenings and other tests.

Slaton says her physicians take time with her. For example, “When I was going through a divorce, my doctor made certain if I was under a lot of stress, I could attend a special support class, if needed.” They also offer a number of wellness classes, like weight management, she said.

Take time to understand your Medicare Advantage plan’s rules and regulations. Each may charge different out-of-pocket costs and have varied rules for how you get services (e.g., whether you need a referral to see a specialist or can use only doctors, facilities or suppliers within the network).

Prices vary by plan provider, so it’s worth the time to compare all available plans in your area. Your costs may differ based on the services you use and the type of plan you purchase.

When shopping for your plans, take several things into consideration:

■ If you prefer one-stop shopping, an Advantage (or Part C) plan may be the right choice.

■ If your primary care provider is someone who is not in the network and changing physicians is something you don’t want to do, you may prefer Parts A and B only.

■ Look closely at costs.

■ Lastly, only you can decide if you want to combine Part D (the drug or medication plan) with Part C. That, too, can be a Part C option.

What About Changing Plans?

Not everyone is happy with their Medicare Advantage plan. But being unhappy doesn’t give anyone the right to switch at any time just because they want to. Several time periods are designated for changing plans, according to Medicare.gov. These include the following:

■ Annual open enrollment period (Oct. 15 to Dec. 7): Coverage in the new plan begins Jan. 1.

■ Annual disenrollment period (Jan. 1 to Feb. 14): This specifically gives you the opportunity to switch from a Medicare Advantage plan [back] to the original Medicare (but not to a different Advantage plan). If you drop your plan in January, coverage in original Medicare begins Feb. 1; if you drop it in the first two weeks of February, coverage begins March 1.

Certain circumstances can affect your flexibility to change plans. For example, you may be able to switch to another type of coverage, such as a different Medicare Advantage plan or original Medicare. It’s best to check Medicare. gov to see what your circumstances allow.

This is general information to help older adults begin learning about Medicare.

For specific and personal information, contact Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

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