When choosing a Medicare Advantage plan, many people are concerned that the choice to deal with a private insurance company is one that sets them up for all kinds of trouble. While Original Medicare — operated by the federal government — has existed for decades and is considered a success by the majority of its beneficiaries, private insurance is looked at with suspicion by many. However, it may not necessarily be the case that opting for a Medicare Part C plan means you will have to deal with unnecessary delays, problems, or paperwork. Here is a quick overview of the facts.
Medicare Advantage plans are known as “Medicare Part C” because they cover everything that Original Medicare plans cover under what’s known as Part A and Part B. For that reason, they can be considered to be “A + B” Plans. Having a Part C plan does not mean you will ever encounter any trouble getting coverage for anything that is already covered by Part A or Part B. These areas are settled law and non-controversial — a company simply is not allowed to “maneuver” its way into non-payment of claims covered by A and B. If they engage in this kind of behavior, they risk legal repercussions.
However, you will have to be careful about the areas of your Medicare Advantage plan not covered by Original Medicare. In this area, private companies have all the leeway that has earned some insurance agencies their negative reputation. In order to protect yourself from insurance issues, you will have to remain aware of your Part C coverage and how it might change each and every year. This means reviewing your policy documents or working with an expert who can do so for you. It also means being familiar with the process for challenging a decision when a medical procedure is deemed not covered by your policy.
All in all, it is absolutely true that a Medicare Advantage plan requires you to take more action and be more informed. However, your likelihood of dealing with these issues is still relatively low. You will have to be proactive and prepared, and understand the limitations of your policy, but that does not mean you will constantly be under siege by your insurance company. On the contrary, a Part C plan can be an excellent decision if you know that you have frequent needs not covered by Part A or Part B, such as hearing aids or vision maintenance requirements.