Medicare Advantage

A Medicare Advantage plan (also known as Medicare Part C) is a Medicare plan offered by a private company that contracts with Medicare to provide you all your Original Medicare Parts A (hospital coverage) and B (medical coverage) benefits, as well as any additional coverage offered through that plan.

In addition to providing hospital and medical coverage, these plans also typically include Part D (prescription drug coverage), which is not covered by Original Medicare.

Some Medicare Advantage plans include additional benefits such as vision, hearing and dental coverage and even fitness programs. These plans help simplify the complexity around Medicare, may offer more comprehensive benefits, yet can also be cost-effective.

The majority of Medicare Advantage plans work like a traditional HMO where you choose a primary care doctor to manage your health care and provide a more coordinated approach to your care.

Special Needs Plans

Millions of Americans are eligible for Medicare Savings Programs and Extra Help, but not yet enrolled. These programs help qualifying patients with limited income and resources pay Medicare’s cost-sharing expenses, including premiums, deductibles, and coinsurance.

These plans can help qualifying patients who are eligible for both Medicare and Medicaid or who have specific chronic diseases. You can learn more about these plans at Medicare.gov or by speaking to a licensed insurance agent to find out whether you are eligible for additional assistance. Medicare Advantage Special Needs plans require eligibility.

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Medicare Advantage Plans:

• Facilitate a more coordinated approach to your care, including referrals to specialists from your primary care doctor, if required
• May provide affordable costs for doctor visits (including low or no co-pays)
• May include affordable prescription drug coverage
• Are required to limit your annual out-of-pocket costs, unlike Original Medicare
• Offer preventive services, including annual physicals, and may offer more comprehensive coverage including, X-ray and lab services, routine dental and vision care
• May result in better health outcomes for patients
• Offer the same peace of mind when traveling as Original Medicare—with urgent and emergency coverage access nationwide

This is not a complete description of benefits.

Medicare Advantage patients:

• Are twice as likely to receive preventive care
• Are half as likely to go to the emergency room
• Go home from the hospital one day earlier
• Are less likely to be readmitted to hospital after discharge*

*When compared to people on fee-for-service Medicare.
Source: The Boston Consulting Group: Alternative Payer Models Show Improved Health-Care Value. May 2013.

Sutter Health recommends choosing the right Medicare Advantage plan for you.

Required Disclaimers to Medicare Plan Options:

¹To receive premium-free Part A at 65:
- You receive or are eligible to receive retirement benefits from Social Security or the Railroad Retirement Board
- You or your spouse had Medicare-covered government employment
²Your monthly premium, on average, if you pay your Part B premium through your monthly Social Security benefit
³Monthly premiums and annual deductibles are based on a Medicare eligible patient in the Sacramento area, Jun. 2018

This information is not a complete description of benefits. Benefits, premiums, and copayments will vary based on the plan options for which you qualify, and may change on Jan. 1 of each year. You must continue to pay your Medicare Part B premium. Eligibility may be limited to certain times of the year. ^***Medicare Supplement Insurance Plans may only be used in conjunction with Original Medicare.

Visit Medicare.gov