Monday-Friday | 8am to 8pm CST

Speak with a licensed agent • Hablamos Español

1 (855) 474-6234 | TTY-711

Monday-Friday | 9am to 8pm CST
Search Here

Speak with a licensed agent!

1 (855) 474-6234 TTY-711

Medicare Part C

medicare part c banner.png

What is Medicare Part C? 

Medicare Part C, known as Medicare Advantage, is a type of plan offered by private insurance carriers who have a contract with Medicare and are required to offer the same benefits as Original Medicare, however, you don’t lose Original Medicare by enrolling in a Medicare Advantage plan. 

 

How Medicare Advantage Plans Work

The plan will issue an id card that you will present when you receive Medicare services. Your provider and or hospital will bill the plan directly, instead of Medicare, for all services rendered. The Part C plan will pay 100% of approved Medicare services less co-pays and coinsurance as stated in the contract. Medicare Advantage plans usually have a low to zero monthly premium, and typically include prescription drug coverage. The benefit of a Part C plan is the controlled costs as it has a  “pay as you go” in addition to a  Maximum Out of Pocket benefit, which means, if you spend a certain amount for medical services, the plan will take over all further costs for the remainder of the year. This is NOT a deductible.  These plans MAY also include extra benefits not covered by Original Medicare such as vision, dental, gym memberships, or other; it will depend on your service area and the carrier. 

 

How Do I Apply to Medicare Part C?

Plans require you meet the following conditions:

  1. You must have both Medicare Part A & B (continue to pay your Part Bpremiums)
  2. Live in the service area of the plan
  3. Not have End-Stage Renal Disease (ESRD)

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

 

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 Election Period (AEP) between October 15th and December 7th each year. Your coverage will be effective on January 1st of the following year
  • Any other Special Election Period (SEP) approved by Medicare 

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

  

Click to call one of our agents from Trusted Senior Specialists!

 

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

There are several different types of Medicare Advantage Plans. You can use the information below to compare the different types of plans to help determine which plan may best meet your needs.   

Your health changes annually and so do plans. It is advised in the Medicare and You Handbook to do a review each fall during the Annual Election Period, also referred to as the Open Enrollment Period. 

Medicare Advantage Prescription Drug Plan (MAPD)

  • Provides Medicare Part A, hospital, coverage
  • Provides Medicare Part B, medical, coverage
  • Provides Medicare Part D, prescription, coverage. Be sure to check the formulary list to verify your medications are covered by the plan. Formularies vary by plan and carrier

Medicare Advantage (MA)

  • Provides Medicare Part A, hospital, coverage
  • Provides Medicare Part B, medical, coverage
  • Does NOT include prescription coverage. This plan may be ideal for Veterans who utilize the VA or those who have other Creditable Coverage

 

Health Maintenance Organization (HMO)

  • You visit only the physicians, other health care providers, or hospitals that are in the plan’s network, except in urgent or emergency situations. You must obtain a referral from your primary care physician in order to see other doctors or specialists, or to undergo testing. 
  • Prescription drugs are covered with these plans, check the formulary
  • In general, you will have to select a primary care doctor, PCP. You are allowed to change your PCP for another in the network

 

Preferred Provider Organization (PPO)

  • While PPOs do have network providers, you may go to any doctor or hospital you choose that accepts Medicare. If you elect an out-of-network provider however, you will pay a higher cost
  • Prescription drugs are covered with these plans. Review the formulary list to verify your medications are covered
  • In most cases you will not need to select a primary care doctor, PCP, although some plans may require a selection at enrollment. You have the right to change your PCP
  • 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! Also, a physician can choose to stop accepting the plan at any time, even if they treated you prior
  • The plan will determine how much it will pay for your treatment and how much you must pay when care is received
  • 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 (MSA)

MSA plans are high-deductible plans. With an MSA, the plan deposits money into your account, you cannot contribute to this account, and you may use that money for any health care services. If, however, it is used for a Qualified Medical Expense, it will count towards the plan’s high deductible.

  • Prescriptions are not covered. You would have to join a Medicare Prescription Drug Plan (Part D) 
  • Deposits will carry over year to year and may earn interest
  • 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)

SNPs limit membership and tailor benefits to provide health care for beneficiaries who have both Medicare and Medicaid, reside in a nursing home, or have specific chronic medical conditions

  • 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
  • Medicare SNPs typically have specialists in the diseases or conditions that effect their members

 

How Much Does Medicare Part C Cost?

 You must continue to pay your medicare Part B premium. Each Medicare Advantage Plan will have its own set of costs regarding co-pays and coinsurance. Most plans have a low to zero monthly premium, while few plans may have yearly deductibles. Also, your costs are determined by whether you have Medicaid or receive assistance for your prescription drugs.

 

For more Medicare information and assistance, click the options below:

More Medicare Info  Check Out Our Blogs  Talk to a TSS Agent

 

 

Subscribe to Our Blog!

HERE WHAT OUR CUSTOMERS SAY ABOUT US!
undefined