Medicare Part C: What You Should Know about Medical Advantage Plans

What is Medicare Part C?

Original Medicare (Medicare Parts A and B) is provided by the federal government. Medicare Part C is an alternative to Original Medicare. These plans are offered and managed by private insurers approved by Medicare.

You may have heard of Medicare Advantage and are wondering, what is a Medicare Advantage plan? Medicare Advantage is simply another name for Medicare Part C. Medicare Advantage plans combine the hospital and doctor coverage of Medicare Parts A and B into one plan, often with extra benefits like routine dental, vision and hearing care. Many Medicare Advantage plans include prescription drug coverage (Medicare Part D). Medicare Advantage plans also offer the protection of an annual limit on out-of-pocket costs. This limit varies by plan.

Medicare Advantage eligibility is based on your eligibility for Original Medicare. If you’re enrolled in Medicare Part A and Medicare Part B, you are typically eligible for a Medicare Advantage plan. You must also live in the area that the Medicare Advantage plan services.

You can learn more about and compare the Medicare Advantage Plans available in your area with the HelloMedicare Guided Path tool.

What Does Medicare Part C Cover?

A Medicare Advantage plan (i.e. Medicare Part C coverage) is required to provide all the hospital and medical benefits included in Original Medicare. The only exception is hospice care. This benefit continues to be covered by Medicare Part A.

Now you might be wondering, how does Part C differ in coverage options from those offered under Original Medicare (Part A and B)? In addition to the standard benefit package, most Medicare Advantage plans also cover services not offered by Original Medicare. These typically include routine dental visits, vision screenings, hearing care, health club memberships and wellness services. Certain plans have even started to cover other helpful services such as acupuncture, pest control, rides to/from the grocery store, just to name a few. Many Medicare Advantage plans also include prescription drug coverage (Medicare Part D).

Another difference between Original Medicare and Medicare Advantage is the healthcare providers you can see. Original Medicare does not have a network and enrollees can see any provider who has been approved by Medicare. With Medicare Advantage plans, you generally need to use certain doctors, hospitals, pharmacies and other healthcare providers. These are called in-network providers.

There are several types of Medicare Advantage plans.

Health Maintenance Organization plan (HMO): A Medicare Advantage HMO plan allows you to see healthcare providers who participate in the plan’s approved provider network. If you’re considering a Medicare Advantage HMO plan, it’s a good idea to check if your preferred doctors and providers are in the plan network. HMO plans typically only cover providers in the plan network. You’ll also typically need a referral to see a specialist.

Point-of-Service plans (POS): Medicare Advantage POS plans have all the benefits of an HMO plan, but with more choice in providers. A POS plan covers both in-network and out-of-network services, but you typically pay less when using an in-network provider.

Preferred Provider Organization plan (PPO): A Medicare Advantage PPO plan covers both in-network and out-of-network providers. Unlike Medicare Advantage HMO plans, you don’t need a referral to see a specialist. These plan premiums are generally higher than HMO or POS plan premiums.

Private Fee-for-Service plan (PFFS): With a Medicare Advantage PFFS plan, the insurance company offering the Medicare PFFS plan determines how much it will pay providers and how much you will pay when you receive care. In order to have your services covered, your provider must accept the plan’s payment terms. These plans may or may not have provider networks.

Medical Savings Account plan (MSA): A Medicare Advantage MSA plan combines a high deductible with a special savings account to help you save for that deductible. The money saved in the account is tax-free as long as it is used on IRS-qualified medical expenses, including the plan’s deductible. With this plan, you can see any provider you choose. Medicare Advantage MSA plans do not include prescription drug coverage.

Special Needs Plans (SNP): Medicare Advantage SNP plans are designed for people with certain special needs. These plans cover individuals who live in institutions, who have certain severe or disabling chronic illnesses or are eligible for both Medicare and Medicaid. These plans always include prescription drug coverage.

How Much Does Medicare Part C Cost?

Unlike Original Medicare, Medicare Advantage plans are offered by private insurers. That means private insurance companies determine the monthly premiums and cost-sharing structure (i.e., deductible, copays, coinsurance) for each of their plans.

What you pay for a Medicare Advantage plan depends on a number of factors. These factors include the monthly premium, whether or not the plan has a deductible, copays or coinsurance for each service, the type and amount of care you need and whether you use in-network providers. Unlike Original Medicare, Medicare Advantage plans have a limit on the amount of out-of-pocket costs you pay every year.

Keep in mind that in order to enroll in a Medicare Advantage plan, you must be enrolled in Original Medicare (both Parts A and B). This means that you will need to continue to pay your Medicare Part B premiums to remain eligible for your Medicare Advantage plan.

For more information, please visit: Part C costs | Medicare

When and How Can I Sign Up for Medicare Part C?

When you first become eligible for Medicare, you are automatically enrolled in Original Medicare (Parts A and B). You can switch to a Medicare Advantage plan during your Initial Enrollment Period (IEP). Your IEP is a seven-month period that begins 3 months before you turn 65, your birthday month and the three months after you turn 65. Around this same time, you should receive your Medicare Card in the mail, which contains your unique Medicare number. It is helpful to have this card and number available when you begin enrollment in Medicare Advantage.

If you are outside of your IEP, you must wait until the Annual Enrollment Period (AEP) to enroll in a Medicare Advantage Plan. The AEP runs from October 15 through December 7 every year.

Because costs and coverage vary by plan, it’s important to understand each plan’s specific details. Start by researching the Medicare Advantage Plans available in your area using HelloMedicare’s personalized Guided Path tool. Be sure to compare monthly premiums, cost-sharing (i.e., deductibles, copays, coinsurance), out-of-pocket maximums and plan details like provider networks and prescription drug coverage.

When you find a plan that fits your healthcare needs and your budget, HelloMedicare can help you enroll in a Medicare Advantage plan too. Simply click “enroll” on the plan description page. Have your Medicare Card ready when you begin the enrollment process.

We understand that choosing a plan can be overwhelming. That’s why HelloMedicare is standing by to help. Our licensed agents can answer any questions you have, from “What is a Medicare Advantage plan?” to “How do I sign up for Medicare Part C?” to “What plan is right for me?” Just ask.