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Advantage Plans

Medicare Advantage (Part C) Plans in Florida

Medicare Advantage is a specific type of Medicare also known as Medicare Part C. The Medicare Advantage plan offers individuals an alternative to Parts A and B. While Medicare Advantage is a Medicare approved program, this health insurance is delivered through private companies. In order to obtain Medicare Advantage, you’ll need to be entitled to Medicare Part A and enrolled in Medicare Part B. You’ll continue to pay the part B premium and you’ll retain all of your full Medicare rights—but you’ll have additional benefits that aren’t part of your Medicare coverage. Many people opt for Medicare Advantage as it can provide stable costs for dental, vision and alternative care. Since Medicare Parts A and B don’t offer full coverage of all health care needs, getting additional coverage through a Medicare Advantage plan can be a smart move.

According to the Florida Department of Financial Services:

In January, 2003, Medicare began offering people Preferred Provider Organization health plans (PPO) in Florida. Benefits vary depending upon what each individual PPO offers in each market, but some of the common features of the PPOs are:

  1. Networks of preferred providers (hospitals, physicians and other providers);
  2. Access to providers outside the network;
  3. A balance of monthly premiums and some cost sharing amounts paid by the plan enrollees;
  4. Fees paid to out-of-network providers will be no more than they would get in fee-for-service Medicare

Under most Part C plans, there’s a formal limit to how much you have to pay out-of-pocket each year for in-network medical services normally covered under Medicare Parts A and B. This limit is called the “maximum out-of-pocket amount for in-network medical services.” In Florida, during 2012, the most you have to these services is $4,500.

An important note, related to out-of-pocket maximums: Once you’ve reached the maximum, most Florida Part C plans prohibit providers from mixing in additional separate charges—sometimes called “balance billing”—that they send to you directly. This prohibition applies even if the plan pays a provider less than the provider charges for a service or if there’s some other dispute between the plan and the provider.

Another important note: To qualify for some Part C plans in Florida, you must be entitled to Medicare Part A and enrolled in Part B. Usually, the Part C plan administrator will help you make sure this “paperwork” is in order—but it’s important that you realize Florida rules may require you to enroll in Part B even if you’re using a Part C plan.

You can find more information comparing the HMOs, PPOs and other plans available under Medicare Part C at the website of the Florida Health Care Plans (a Blue Cross/Blue Shield affiliate organization).