Part C

Medicare Advantage Plan

A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare.

 

If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. In most cases, you’ll need to use health care providers who participate in the plan’s network.

Some plans offer out-of network coverage. Remember, in most cases, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.

Part C Costs

To be enrolled into any Medicare Advantage Plan, you will be charged a Part B premium. In 2022, the least amount that the Part B premium will be is $170.10/month unless you qualify for Limited Income Subsidy.

 

Of the 523 Medicare Advantage Plans sponsored by the state of Florida, their premiums range from $0/month to over $150/month.

Part C Coverage

The four major types of Medicare Advantage Plans in Florida are:

• HMO—Health Maintenance Organization (HMO)

o Usually requires patients to use health care providers and pharmacies that are part of a network

o Usually requires a referral from a primary doctor in order to see a specialist.

• PPO—Preferred Provider Organization (PPO)

o Beneficiaries can see providers outside of their plan’s network, normally at a higher cost.

o Usually do not require patients to acquire a referral before visiting with a specialist.

• PFFS—Private Fee-For-Service (PFFS)

o This plan determines how much it will pay to health care providers and how much the patient will pay when care is received.

o With a PFFS plan, you can typically receive care from any doctor, hospital, or health care provider that accepts your plan’s terms.

o Not all providers will accept your plan’s terms.

• SNP—Special Needs Plan (SNP)

o Is a type of plan limited to people with specific diseases or characteristics.

o SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve