Jan 29th, 2012 | By | Category: Social Security & Medicare

Medicare Advantage Part C

One of SCJ editors had an interesting experience recently with Medicare Part C.  That is the Medicare Advantage program which seniors can opt for instead of Original Medicare. Medicare Advantage programs are offered by private insurance companies and provide coverage for hospitals, medical and prescription drugs; they replace Original Medicare.

A family member enrolled in a Medicare Part C program when he turned 65 recently.  There are hundreds of thousands of people enrolled in this particular insurance company’s program, and it is touted rather highly among the enrollees. One of the attractions is that for many seniors who enroll, there is no additional monthly premium (other than what is withheld from their Social Security checks).  So, after verifying that his physicians were covered by the plan, a brother enrolled in the program recently.

When he went to a specialist who has been treating him over a year, and who is covered by the Medicare Advantage plan he chose, he discovered the medical facility in which he was seen did not have a contract with his Medicare Advantage Part C plan, and therefore those facility costs were not covered for his visit.

Weigh the Pros and Cons of Part C versus Original Medicare

My brother and I had a long drive home, so we talked about whether or not he should convert back to Original Medicare and a Medigap supplement. We talked about the costs with both options, and here’s where we came out:

  • The facility cost was equal to what he would be paying with a Medigap policy for an estimated two or three months of premium, so he’s still better off financially with the Medicare Advantage Plan;
  • If he discovers that there are several facility costs that arise this year that are not covered, at the end of the year he can total all that he paid that is not covered and compare that to what he would pay with a Medigap policy of his choice;
  • By the end of the year, he will know whether it is prudent to remain with the Medicare Advantage Plan or convert back to Original Medicare and a Medigap policy.

So far the Medicare Advantage plan (Part C) is winning.




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