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Advantage Plans

Medicare Advantage (Part C) Plans in South Carolina

Medicare Advantage Plans are healthcare plans approved by Medicare and provided by private insurance companies. There are several different types of plans:

  • Health Maintenance Organization (HMO).
  • Plans must cover all Part A and Part B health care. Most require you to go to doctors, specialists, or hospitals on the plan’s list, except in an emergency.
  • Preferred Provider Organization (PPO). Plans are available in a local or regional area and you may pay less if you use doctors, hospitals, and providers in their network, but pay additional costs for outside network visits.
  • Private Fee-for-Service (PFFS). Plans allow you to go to any doctor or hospital that accepts the plan’s payment. The plan decides how much it will pay and what you will pay for the services you receive.
  • Medicare Special Needs (SNP) . Plans are specially designed to meet the needs of people who live in certain institutions, are eligible for both Medicare and Medicaid, and/or have one or more chronic conditions.

Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and all of your Part B

(Medical Insurance) coverage and other medically necessary services just like you have under Original Medicare.

Medicare Advantage Plans may provide good coverage for some beneficiaries. You must make sure you can afford to pay any co-payments as well as the monthly premium. You also need to check to see if your healthcare providers are part of the plan’s network or if they will accept payment.

It is important for people who now have Original Medicare and are considering enrolling in any Medicare Advantage Plans to understand:

  • The Plan will provide your primary health coverage instead of Original Medicare.
  • Original Medicare will no longer pay for your health care once you enroll in the plan.
  • You will be given a new Plan card to be used instead of your Medicare card.
  • You will keep your Medicare card and continue to pay your Part B premium even if you enroll in a Medicare Advantage Plan.
  • The plan is not a Medicare Supplement Plan, and it does not replace Medicare Supplement Insurance (Medigap).
  • You may be charged extra co-payments or cost-sharing expenses for Medicare services.