(813) 761-3457 (TTY: 711)
Medicare Advantage (Part C)
What are Medicare Advantage (Part C) plans?
Medicare Advantage (also called Medicare Part C or "MA" plans) are alternative plans to Medicare Part A and B that are provided by private, Medicare-approved companies.
Why Choose a Medicare Advantage Plan?
MA plans cover a wide range of services including:
Inpatient hospital care
Skilled Nursing Facility (SNF) care
Hospice
Home Health care
Outpatient doctor visits
Preventive screenings (e.g. Cardiovascular and cancer screenings)
Diabetes screenings and supplies
Wellness visits (e.g. flu and vaccinations)
Certain ambulance services and transportation
Maximum out-of-pocket limits
Additionally, many MA plans offer a wide range of extra benefits not provided by Original Medicare including:
Dental
Vision
Hearing
Fitness (e.g. gym memberships)
Transportation to doctor's appointments
MA plans are available as HMO or PPOs:
HMO (Health Maintenance Organization) - These plans typically require referrals from your primary care physician to see a specialist. Importantly, these plans do not provide out-of-network coverage except for emergency or urgent care. In other words, if you are traveling and seek non-emergency care from an out-of-network hospital or provider, your HMO plan will not cover these expenses.
PPO (Preferred Provider Organization) - These plans allow you to see specialists without a referral from your primary care physician. Unlike HMO plans, with a PPO you can see out-of-network providers for non-emergency care, although there is typically a higher cost than when you see your in-network provider.
Maximum Out of Pocket Limit
Original Medicare (Part A and B), does not have a limit on your maximum out of pocket costs.
For Medicare Advantage plans, your maximum out of pocket costs vary depending on the plan; however, these are capped at $8,500 for in-network services for 2023.
Because Original Medicare does not include a maximum out-of-pocket limit, you could pay more than $10,000 or more for services.
What is covered?
Inpatient Hospital Coverage
MA plans cover your inpatient hospital coverage including:
"Room and Board"
Semi-Private room and bed
Nursing care
Medication
Lab services
Medical supplies
Three meals per day
Skilled Nursing Facility Care
Skilled Nursing Facility (SNF) care includes:
Physical therapy
Occupational therapy
Speech-language pathology services
Medical social services
Medication
Certain Ambulance transportation
Dietary/nutrition counseling
Home Health Care
MA plans cover a wide range of services from the comfort of your own home including:
Wound care for pressure sores or a surgical wounds
Patient and caregiver education
Intravenous or nutrition therapy
Injections
Monitoring serious illness and unstable health status
Outpatient Office Visits
Outpatient physician visits are also covered as part of your MA plan
Outpatient physician office visits
Preventive screenings
Primary Care
Specialists
Preventive Care & Wellness
MA plans cover a variety of preventive care services and wellness initiatives:
Diabetes screening and supplies
Medical and cancer screenings
Annual wellness visits
Flu shots and vaccinations
Mobility Equipment
Durable medical equipment is covered if you have a disability that prevents you from bathing, toileting, personal care, feeding or dressing
Canes
Walkers
Scooters
Wheelchairs
Oxygen tanks
How do I enroll?
To enroll in a Medicare Advantage (Part C) plan:
Enroll in Medicare Part A and B
If you are new to Medicare, you must pay Part B monthly premiums (the standard premium in 2023 is $164.90 per month).
Contact us to review plan options in your area.
Interested in a Medicare Advantage plan?
Contact us to review options available in your area
(813) 761-3457
Robin@ZelinskyInsuranceGroup.com
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please visit Medicare.gov or
call 1–800-MEDICARE for information on all of your options and eligibility.
We are not affiliated with, connected to, or endorsed by the United States government or the federal Medicare program.
