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Health Care Fraud

Medicare Part C (Medicare Advantage)

Medicare Advantage plans are offered by private insurance companies that sign a contract with Medicare.  The plans provide Medicare-covered benefits to Medicare members through the plan and may offer extra benefits that Medicare doesn’t cover, such as vision or dental services.  Medicare Advantage plans replace A, B, and any supplemental insurance (sometimes called “Medigap”) when elected.

There are five different types of Medicare Advantage plans:

  1. Medicare Managed Care Plans (HMOs) – Members must see doctors in the plan’s network.  A primary doctor coordinates health care.
  2. Medicare Preferred Provider Organization Plans (PPOs) – Members may see any doctor, but it costs less to see doctors in the plan’s network.
  3. Private Fee-for-Service Plans – Members may see any Medicare-approved doctor or hospital if they agree to the plan’s terms and conditions of payment before treatment.  Not all health care providers accept the plan’s payment terms or will agree to treat you.  The plan decides how much they will pay the providers and how much they will charge the beneficiary.
  4. Medicare Specialty Plans – Plans are not available everywhere.  They provide all Medicare health care for certain people with Medicare with special needs, such as chronic illness, people in institutions, and dual eligible individuals.
  5. Medicare Medical Savings Account Plans – These have two parts.  One part is a Medicare Advantage Plan with a high deductible, and one part is a Medical Savings Account into which Medicare deposits money that people can use to pay health care costs.

Eligibility

  • Must be enrolled in Medicare A and B.
  • Must live in the plan’s service area.
  • May not have end-stage renal disease at time of enrollment.

Part C Costs (vary according to plan selected)

  • The Part B premium applies.
  • There may be an additional premium.
  • Co-payments may apply.
  • Medicare supplemental policies do not pay secondary to Medicare Advantage plans.


Covered and Non-covered Services vary according to plan selected.

 

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