What is Medicare Part C?

 

Also known as Medicare Advantage Plans, Part C is offered by private insurance companies approved by Medicare. These plans provide Part A and Part B, and most times Part D as well. Medicare Advantage Plans are offered by private insurance carriers who have a contract with Medicare and are required to offer the same benefits as Original Medicare.

The plan will issue an ID card and your provider will bill the plan for all services rendered instead of Medicare, however, you don’t lose Original Medicare. These plans MAY include extra benefits not covered by Original Medicare such as gym memberships, vision, hearing, and dental services; it will depend on your service area and the carrier you choose.

The benefit of a Part C plan is the controlled costs as it has a  “pay as you go” feature.  

 

What Does Medicare Part C Cover?

What Are The Different Medicare Advantage (Part C) Plans?

There are several different types of Medicare Advantage Plans. You can use the information on the following pages to compare the different types of plans to help determine which plan may best meet your needs. Medicare Advantage Plans usually have a low to zero monthly premium and typically include prescription drug coverage.  

Your health changes annually and so do plans. It is advised in the Medicare and You 2016 handbook to do a review each Open Enrollment Period.

 

Health Maintenance Organization (HMO)

  • You generally must go to a doctor or hospital in the plan’s network. In some plans you may be able to visit a provider who is out-of-network for a higher cost.
  • Prescription drugs are covered with these plans. Ask before joining if you need drug coverage to be sure.
  • In general, you will have to select a primary care doctor.
  • You will need a referral from your primary care doctor in order to be seen/treated by a specialist.

 

Preferred Provider Organization (PPO)

  • While PPOs do have network providers, you may go to any doctor or hospital you choose. If you elect an out-of-network provider however, you will pay a higher cost.
  • Prescription drugs are covered with these plans. Ask before joining if you need drug coverage to be sure.
  • You will not need to select a primary care doctor.
  • You will not need a referral in order to be seen/treated by a specialist.

 

Private Fee For Service (PFFS)

  • You can go to any Medicare-approved doctor or hospital that accepts the plan’s payment terms and agrees to treat you. NOT ALL WILL!
  • Sometimes prescription drugs are covered. Ask before joining. If not included, you may join a Medicare Prescription Drug Plan (Part D) to get coverage.
  • You will not need to select a primary care doctor.
  • You will not need a referral in order to be seen/treated by a specialist. NOTE: PFFS IS NOT THE SAME AS ORIGINAL MEDICARE

 

Medical Savings Account Plan (MSAP)

  • You can go to any doctor or hospital you choose. Some plans may have preferred providers you can go to for a lower cost.
  • Prescriptions are not covered. You would have to join a Medicare Prescription Drug Plan (Part D) to get coverage.
  • You will not need to select a primary care doctor.
  • You will not need a referral in order to be seen/treated by a specialist.

 

Special Needs Plan (SNP)

  • Generally, you must get care from doctors or hospitals in the plan’s network.
  • Prescription drugs are always covered. Part D must be included in all SNPs.
  • You will need to select a primary care doctor.
  • In most cases, you will need to get a referral from your primary care doctor in order to be seen/treated by a specialist.

 

When Should I Apply For Medicare Part C?

When can I join, switch or drop a Medicare Advantage Plan?

You can join a Medicare Advantage Plan during the following times:

During your 7-month Initial Enrollment Period (IEP) which is:

  • the 3 months prior to the month you turn 65
  • the month of your 65th birthday
  • the 3 months after
  • During the three months before, to three months after, of your 25th month of disability
  • During Annual Enrollment Period (AEP), between October 15 and December 7 each year. Your coverage becomes effective on January 1.

 

NEW: Beginning in 2011, you will be able to disenroll from a Medicare Advantage Plan and return to Original Medicare between January 1 – February 14. This period is known as The Medicare Advantage Disenrollment Period (MADP). If you choose to disenroll from a MAPD, you will need to select a Prescription Drug Plan (PDP) if you do not have drug coverage.

 

How Do I Apply to Medicare Part C?

To enroll in a Part C plan you must stay enrolled in Medicare Part A and B, live in the plan’s service area, and not have ESRD (End Stage Renal Disease). It is illegal for an agent to sell you a Medigap policy in addition to a Medicare Part C plan.

 

Who can join a Medicare Advantage Plan?

Medicare Advantage Prescription Drug (MAPD) plans require you meet the following conditions:

  1. Have Part A & B
  2. Live in the service area of the plan
  3. You don’t have End-Stage Renal Disease (ESRD)

Note: In most instances, you can only join a Medicare Advantage Plan at certain times during the year.

 

How Much Does Medicare Part C Cost?

This will vary dependent on the following:

  • Whether the plan charges a monthly premium in addition to your Part B premium.
  • Whether the plan pays any of your Part B premiums for you.
  • Whether the plan has any deductibles.
  • How much the plan’s copayment or coinsurance is for each doctor visit or service.
  • What the plan’s yearly limit is on your out-of-pocket costs for all medical services.