Medicare Part C – Medicare plus Choice – are Medicare Advantage plans. You have the option to select a Medicare Advantage plan because you have Medicare Part A and B. Medicare Advantage plans often include Part D prescription drug coverage with medical coverage as well as some additional benefits; i.e, dental. Plans may have a zero premium or require an additional premium. Medicare pays the Medicare Advantage plans so much per beneficiary member per month to take care of you.
Some Medicare Advantage plans provide a “gatekeeper” system (all of your doctors must be in the same medical group AND accept the Medicare Advantage plan you are interested in. Other plans may allow you to use doctors in network and out of network. All Medicare Advantage plans must identify what your maximum out of pocket cost will be per year for your medical expenses; should you exceed the plan’s limit, you will not be responsible for those medical costs.
Before deciding on a Medicare Advantage plan, you will want to make sure that (1) all of your doctors are in the same medical group and which Medicare Advantage plans that medical group takes; (2) that all of your drugs are covered by the plan and covered most cost effectively; (3) if you have specific medical coverage needs, how do the copays compare for the various Medicare Advantage plans your medical group takes; and lastly (4) what is the maximum out of pocket costs you will incur for your medical care should you have a difficult health year.