Medicare Advantage (also known as “Part C”) is a type of Medicare health plan offered by a private company that contracts with Medicare. These plans include Part A (hospital insurance), Part B (medical insurance), and usually Part D (drug coverage). Medicare Advantage Plans may offer some extra benefits that Original Medicare doesn’t cover. One such benefit is called OTC, which stands for Over the Counter. It offers a set amount, depending upon your specific plan, sometimes as much as $100 per quarter, where you can order some everyday over-the-counter medicine and related items allegedly free to you. That means you won’t have to pay out of pocket costs at the time of ordering these kinds of products. The products, whether for generic aspirin or diabetic socks, are grossly overpriced if you compared them to the same or similar items readily available at stores like Walmart, and the like. Many of these products are exceedingly poor quality too. Vitamins and supplements offered in these plans are junk products filled with extraneous ingredients that don’t belong in the vitamins in the first place.
Since the private companies running these adjunct plans are contracted with Medicare, you can be sure that you are indeed paying for everything they offer through your tax dollars.
When you join a Medicare Advantage Plan, Medicare pays a fixed amount for your coverage each month to the company offering your Medicare Advantage Plan. Companies that offer Medicare Advantage Plans must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or whether you have to go to doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care). These rules can change each year.
With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn’t cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine check ups or cleanings). Plans also have a yearly limit on your out-of-pocket costs for all Part A and Part B services. Once you reach this limit, you’ll pay nothing for services Part A and Part B cover. Of course getting some of these benefits, especially for much needed vision and dental care is important and most will appreciate these as they are not just simply add-ons, they are medical necessities if you want to be able to see and eat properly.
The programs are so complex that these private companies hire out counselors to advise potential customers of their benefits and get them to sign on the dotted line for their preferred medical necessity. You have no option but to listen to the sales pitch or do extensive homework on your own to understand the benefits and research all the different companies out there. Good luck. If you are already on Medicare, you’ll be bombarded each year by companies advertising to get you to join a new plan.
Legislators complain endlessly about waste and fraud in the Medicare program, yet they do nothing about the dishonest plans associated with the program or the program itself. Medicare is complex, confusing, and charges people obscene amounts of money toward deductibles, co-insurance, co-payments, maximum out of pocket limits and add-ons that no other technologically advanced country pays for. That’s because our legislators bow to the corporate giants of insurance and pharmaceutical companies rather than to the people they are supposed to be serving. Remember that the next time you hear a politician threaten your social security and medicare that every senior paid into and desperately relies on.
Great information. Thank you.