Medicare Advantage Plans in California

What are Medicare Advantage plans?

Medicare Part A and Part B cover many healthcare costs for seniors, but certainly not all of them. Seniors in California who want more extensive coverage should consider what Medicare Advantage plans offer.

Medicare Advantage plans combine the benefits of federal Medicare with those of private health insurance. Plans include Part A and Part B coverages, along with other protections.

Are Medicare Advantage and Medicare Part C plans the same?

Medicare Advantage and Medicare Part C plans are identical. Medicare Part C terminology is consistent with the “parts” system of Medicare coverages, while Medicare Advantage is a more colloquial term. The two are the same type of plan.

The defining characteristic of these plans is that a private insurance company administers them. Although Part A and Part B are still federally overseen, premiums and claims are funneled through a private insurer. The insurer also offers any additional protections that a particular Medicare Advantage/Part C plan provides.

Who in California should get Medicare Part C?

While Medicare Parts A and B provide important protections, many California seniors may want more coverage than what these afford. Anyone who wants additional protection should consider Medicare Part C.

Other ways to supplement Medicare coverage include through an employer group health insurance policy, with a Medicare supplement plan, or through the Qualified Medicare Beneficiary Program. When employer and QMBP coverage aren’t available, Medicare Advantage may be the best way to supplement coverage. It ought to be reviewed alongside other supplement plan options.

Do all Medicare Part C plans have the same coverages?

While most different Medicare plan letters dictate a specific set of coverages, Medicare Part C plans are somewhat different. They’re primarily defined by how they’re administered — a private insurance company administering both the public and private portions of coverage — rather than what they provide. Coverages included within Part C plans can indeed vary.

To make sure they get a Part C plan that affords the right coverages, seniors should work closely with a knowledgeable insurance agent when comparing plan options. An agent who specializes in Medicare Advantage and supplement plans will be able to make an informed recommendation.

What healthcare expenses do Medicare Part C plans cover?

Depending on a specific plan’s terms and features, Part C plans can cover a variety of healthcare costs that are excluded from Medicare Part A and Part B. Part C plans might help pay for:

• Primary care physician office visits
• Specialist office visits
• Hospital inpatient stays
• Outpatient surgeries
• Tests and scans
• Emergency room and urgent care visits

Do Medicare Advantage plans cover all providers in the U.S.?

Original Medicare Part A and Part B generally provide equal coverage throughout all 50 states. These parts normally don’t have networks, so long as physicians broadly opt into Medicare assignment.

Because Medicare Advantage plans are partially underwritten by private insurance companies, however, the privately underwritten portion can have a provider network. These networks may be statewide, regional or national, and not all providers within the network area participate.

Seniors should consider the network when choosing a plan, as costs for in-network and out-of-network care can vary dramatically.

Can seniors enroll in multiple Medicare Advantage plans?

Federal law generally restricts seniors to only one Medicare supplement plan, which Medicare Advantage plans count as. Even without this regulation, purchasing a second plan would unnecessarily duplicate certain protections in many cases.

Seniors who want extra protection ought to get a more robust Medicare Advantage plan, rather than look for a second one.

How can California seniors get Medicare Advantage plans?

Sorting through all of the standard and optional protections that Medicare covers can be complicated. For help comparing Medicare Advantage plans and other plan options, contact the independent California insurance agents at SEI Agency.