Life’s Spectrum: From Commercial Insurance to Medicare–Part C

Medicare Part C is known widely by its moniker Medicare Advantage plan.

These plans are purchased from commercial insurance companies and their benefits are managed by these companies. These plans must cover all the services covered by Medicare Part “A” and Part “B” except for hospice. Many plans have prescription drug coverage eliminating the need for Medicare Part “D”.

The catchy moniker Advantage has caught on.

The commercials aired on television, social media and in printed brochures sent by USPS stress “advantages” of no premium, no deductible, no or low copay for a visit to a primary care doctor, and no or low copay for some generic medications. If it is applicable, these commercials stress dental or wellness (silver slippers, for example) benefits that are not part of traditional Medicare Part “A” or Part “B”.

These commercials do not explain that the premium deducted by the government from your monthly social security benefit before it transfers the balance into your bank account continues. The premium you may not pay is that for a traditional Medicare Part “B” supplement.

Like other commercial insurance products Medicare Part “C” plans have provider coverage networks with service areas with regional geographic boundaries as well as hospital and provider networks that often do not include all providers who see Medicare patients. Emergency care, urgent care and renal dialysis are covered nationwide.

These plans have precertification for some procedures; an MRI scan or outpatient surgery would be possible examples.

These commercials do not mention the magnitude of the limit of an annual out-of-pocket responsibility when an individual uses his Medicare Advantage plan. Examples of services for which a copay will show its ugly head include specialist visits, many blood tests, x-rays, inpatient hospital days, outpatient surgeries, emergency room visits to name a few. Co-pays add up and in 2018 their limit in Georgia Medicare Advantage plans ranges, with a few exceptions, from $5900 to $6700. This amount of money is significant. We spend this for groceries for two, not insurance for one.

Compare the annual premium for a Medicare Part “B” supplement with the co-pays you anticipate paying in a year. Part of the information you need is tabulated in the government publication titled “Medicare & You 2018. Learn about all the co-pays, not just the ones quoted in the glossy advertisements, before you choose a Medicare Advantage plan. Compare the copay for a procedure with the Medicare allowable. A $30 copay is not a good bargain if the Medicare allowable is $11 or $28.25. A copay of $290 is only a slightly better bargain if the Medicare allowable is $410.

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