Medicare Part C, also known as Medicare Advantage, allows you to receive your Medicare benefits through private insurance plans approved by Medicare. These Medicare Advantage Plans provide an alternate way to get your Medicare coverage that may offer additional benefits beyond Original Medicare.
This article explores what Medicare Part C is, the different types of plans available, eligibility requirements, how to enroll, services covered, and key differences compared to Original Medicare. Read on for an in-depth look at this Medicare option.
What Exactly is Medicare Part C?
Medicare Part C refers to Medicare Advantage Plans. These plans are offered by private insurance companies and provide the coverage you would get under Original Medicare Part A and Part B.
If you enroll in a Medicare Advantage Plan, Medicare pays the plan to cover your Part A and Medicare Part B benefits. You still have Medicare if you join a Medicare Advantage Plan, but your coverage is provided through the private plan rather than Original Medicare.
In addition to the services covered under Parts A and B, many Medicare Advantage Plans also include prescription drug coverage. They also often provide additional benefits Original Medicare does not cover, medical insurance perks such as such as vision, hearing, dental, and more.
Types of Medicare Part C Plans
There are a few main types of Medicare Advantage Plans to choose from:
- HMO: These require you to see in-network providers and get referrals to see specialists. They tend to have lower premiums.
- PPO: These allow you to see out-of-network providers for a higher cost. You don’t need referrals for specialists. Premiums tend to be higher.
- PFFS: These let you visit any provider who accepts the plan’s terms and conditions. The provider submits claims to the plan for reimbursement.
- SNP: These are special needs plans that offer focused benefits for specific conditions or eligibility criteria.
Each type functions a bit differently, so research the options available in your area thoroughly.
Medicare Part C Eligibility Requirements
To join a Medicare Advantage Plan, you must meet these eligibility requirements:
- Have Medicare Part A and Part B
- Live in the plan’s service area
- Be a U.S. citizen or lawfully present
- Not have end-stage renal disease (some exceptions)
You can enroll when first eligible for Medicare, during the Annual Election Period from October 15 to December 7, or sometimes during Special Medicare Advantage open Enrollment Periods if you qualify.
How to Enroll in Medicare Part C Plans
Follow these steps to enroll in a Medicare Advantage Plan:
- Review and compare plans in your area during Medicare’s Open Enrollment Period each year.
- Call the plan provider directly to enroll. You can also enroll on Medicare’s website in many cases.
- You will be disenrolled from Original Medicare when your plan’s coverage begins on January 1.
- Continue paying your Part B premium. You may have an additional premium for your Medicare Advantage Plan.
-coverage starts January 1st when you enroll during Medicare’s fall Open Enrollment Period.
Medicare Part C Covered Services
Medicare Advantage Plans must cover all Medicare Part A and Part B services, including:
- Inpatient hospital stays
- Outpatient services
- Doctor visits
- Preventive services
- Emergency care
- Urgent care
- Laboratory tests
- Durable medical equipment
- Many prescription drugs
Most plans also provide coverage for extra benefits not covered by Original Medicare like dental, vision, hearing aids, health club memberships, transportation to doctor visits, and more. Benefits can vary by plan.
How Medicare Part C Differs from Original Medicare
There are some key differences between Medicare Part C plans and Original Medicare:
- Coverage – Original Medicare is from the federal government. Medicare Advantage Plans are from private insurers approved by Medicare.
- Costs – Medicare Advantage Plans often have lower out-of-pocket costs. Plans have an annual limit on your costs for Part A and B services.
- Drug Coverage – Only some Medicare Advantage Plans include prescription drugs plan. Original Medicare requires a separate Part D Plan for drug coverage.
- Providers – Original Medicare allows you to see any provider who accepts Medicare nationwide. Medicare Advantage Plans have provider networks.
- Referrals – You don’t need a referral to see specialists with Original Medicare. Some Medicare Advantage Plans require referrals.
- Travel – Original Medicare covers you nationwide. Medicare Advantage Plans only cover you in your plan’s service area unless it’s an emergency.
Key Takeaways About Medicare Part C
In summary, important things to know about Medicare Part C include:
- It allows you to get Medicare benefits through private Medicare-approved insurance plans
- You must be enrolled in Medicare Parts A and B
- Many plans include Part D prescription drug coverage
- Provides coverage beyond what Original Medicare covers
- Restricted provider networks compared to Original Medicare
- Monthly premiums and healthcare costs can be lower than Original Medicare
- Enroll during Medicare’s Annual Election Period or when first eligible
Overall, Medicare Part C gives you an alternative way to get your Medicare coverage that may save money and provide
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You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Manatee Insurance Solutions a Call at (352) 221-3779. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
FAQS
What is Medicare Part C used for?
Medicare Part C, also known as Medicare Advantage Plans, is a type of health plan offered by private insurance companies approved by Medicare. It provides all of the benefits of Medicare Parts A and B, and often includes additional benefits such as prescription drug coverage and preventative services. Medicare Part C plans may also offer different cost-sharing arrangements and provider networks.
Who is eligible for Medicare Part C?
In order to be eligible for Medicare Part C, you must meet the following criteria: 1) You must be enrolled in Medicare Parts A and B. 2) You must reside in the plan’s service area. 3) You cannot have end-stage renal disease (ESRD) except under certain circumstances.
How can I enroll in a Medicare Advantage Plan?
To enroll in a Medicare Advantage Plan, you can: 1) Enroll during your Initial Enrollment Period when you first become eligible for Medicare. 2) Enroll during the Annual Enrollment Period, which is from October 15 to December 7 each year. 3) Qualify for a Special Enrollment Period if you experience certain life events such as moving to a new location or losing other health coverage.
What does Medicare Part C cover?
Medicare Part C plans cover all of the benefits provided by Original Medicare (Parts A and B). In addition, some Medicare Advantage Plans may also offer extra benefits such as prescription drug coverage, dental, vision, hearing, and fitness programs. It’s important to review the specific details of each plan to understand what is covered.
How do I sign up for Medicare?
To sign up for Medicare, you can do so during your Initial Enrollment Period (IEP), which is a seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. You can enroll online at the official Medicare website or by contacting the Social Security Administration.
How do I choose a Medicare Advantage Plan?
To choose a Medicare Advantage Plan, you should consider factors such as the plan’s cost, coverage benefits, provider network, and prescription drug coverage. You can use the Medicare Plan Finder tool on the official Medicare website to compare different plans available in your area.
What is the difference between Medicare Advantage and Original Medicare?
The main difference between Medicare Advantage and Original Medicare is that Medicare Advantage Plans are offered by private insurance companies approved by Medicare, whereas Original Medicare is provided by the federal government. Medicare Advantage Plans often include additional benefits not covered by Original Medicare, such as prescription drug coverage and dental, vision, and hearing services.
Are Medicare Advantage Plans available in all areas?
Medicare Advantage Plans are available in most areas of the United States. However, the availability of specific plans may vary by location. It’s important to check with your local insurance providers or use the Medicare Plan Finder tool to see what plans are available in your area.
What are the benefits of Medicare Part C coverage?
The benefits of Medicare Part C coverage include access to additional benefits not covered by Original Medicare, such as prescription drug coverage, dental, vision, and hearing services. Medicare Advantage Plans may also offer different cost-sharing arrangements and provider networks, giving you more options and flexibility in your healthcare.
What are the eligibility requirements for Medicare Part C?
To be eligible for Medicare Part C, you must be enrolled in both Medicare Parts A and B, reside in the plan’s service area, and not have end-stage renal disease (ESRD) except under certain circumstances.
