Medicare
What is Medicare Part C?
Medicare Part C, commonly known as Medicare Advantage, is an alternative to Original Medicare that combines the benefits of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) into one plan. These plans are offered by private insurance companies approved by Medicare and often include additional benefits not covered by Original Medicare, such as prescription drug coverage, vision, hearing, dental care, and health and wellness programs.
Eligibility for Medicare Part C
To be eligible for a Medicare Advantage plan, you must be enrolled in both Medicare Part A and Part B and live in the service area of the Medicare Advantage plan you are interested in. Generally, you must be at least 65 years old and a U.S. citizen or legal permanent resident for at least five contiguous years. Alternatively, you may be eligible if you have received Social Security or Railroad Retirement Board disability benefits for 24 months, have amyotrophic lateral sclerosis (ALS), or have end-stage renal disease (ESRD).
Types of Medicare Advantage Plans
There are several types of Medicare Advantage plans available, each with its own set of rules and benefits.
HMO – Health Maintenance Organization: In most HMOs, you can only visit doctors, specialists, or hospitals that are part of the plan’s network, except in emergency situations. You may also need a referral from your primary care doctor to see a specialist.
HMO-POS – HMO Point of Service Plan: This type of HMO plan allows you to receive some services out-of-network, but at a higher cost.
PPO – Preferred Provider Organization: PPO plans allow you to use doctors, hospitals, and other healthcare providers both in and out of the plan’s network. However, using out-of-network providers typically results in higher copays and coinsurance.
PFFS – Private Fee for Service: PFFS plans allow you to see any doctor, healthcare provider, or hospital that agrees to treat you. The plan determines how much it will pay for these services and how much you must pay.
SNP – Special Needs Plan: SNPs are designed for specific groups of people, such as those with both Medicare and Medicaid, those living in nursing homes, or those with certain chronic medical conditions.
MSA – Medical Savings Account: This plan combines a high deductible health plan with a bank account. Medicare deposits money into the account, which you can use to pay for healthcare services during the year.
Additional Benefits and Coverage
Most Medicare Advantage plans include Medicare prescription drug coverage (Part D) and may offer extra benefits such as vision, hearing, dental care, and health and wellness programs. These plans also have limits on the out-of-pocket costs you pay and cover emergency and urgent care, as well as hospice care, although the latter is still covered by Original Medicare.
Enrollment and Premiums
To enroll in a Medicare Advantage plan, you must do so during specific enrollment periods. The initial enrollment period is typically the three months before, the month of, and the three months after your 65th birthday. There is also an open enrollment period from October 15 to December 7 each year, and a Medicare Advantage open enrollment period from January 1 to March 31 for those already enrolled in a Medicare Advantage plan.
You will need to continue paying your Medicare Part B premium, as well as any premium charged by the Medicare Advantage plan you choose.
Important Considerations
It is important to note that you cannot have both a Medicare Advantage plan and a Medicare Supplement Insurance plan at the same time. Medicare Advantage plans are an alternative to Original Medicare and offer different benefits and cost structures.