Medicare Part C: What You Should Know about Medicare Advantage Plans
Medicare is a federal program that provides healthcare to individuals ages 65 and older and people with qualifying disabilities and illnesses of any age. To be eligible for Medicare benefits, you must be a U.S. citizen or a legal U.S. resident for at least five consecutive years.
Often referred to as Original Medicare, Medicare Part A, and Medicare Part B, cover hospital care and outpatient medical care, respectively. Part C (or Medicare Advantage) is an alternative to Original Medicare offered by private insurers. Part D provides prescription drug coverage.
Understanding Medicare’s parts and how they work together will help you choose the coverage that meets your healthcare and budget needs.
What is Medicare Part C?
Medicare Part C is an alternative to Original Medicare. These plans are offered and managed by private insurers approved by Medicare.
Medicare Advantage is another name for Medicare Part C combining 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.
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, a benefit covered by Medicare Part A.
Most Medicare Advantage plans offer additional benefits beyond what Original Medicare provides. These include routine dental, vision, and hearing care, health club memberships, wellness services, and even coverage for acupuncture, pest control, and grocery store transportation. Many Medicare Advantage plans include prescription drug coverage (Medicare Part D).
Another difference between Original Medicare and Medicare Advantage is the provider network. Original Medicare allows you to see any Medicare-approved provider without restrictions. In contrast, Medicare Advantage plans require using in-network providers, including doctors, hospitals, pharmacies, and other healthcare providers.
There are several types of Medicare Advantage plans.
Health Maintenance Organization plan (HMO):
A plan that lets you see healthcare providers within an approved provider network. You may need a referral to see a specialist.
Point-of-Service plans (POS):
These plans have all the benefits of an HMO plan but with more provider choices. A POS plan covers both in-network and out-of-network services. However, you’ll typically pay less when using an in-network provider.
Preferred Provider Organization plan (PPO):
A plan that 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):
Insurance companies offering Medicare PFFS plans determine how much they will pay providers and how much you will pay when receiving care. Your provider must accept the plan’s payment terms to cover your services. These plans may or may not have provider networks.
Medical Savings Account plan (MSA):
A plan that 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 if used on IRS-qualified medical expenses, including the plan’s deductible. With this plan, you can see any provider of your choice. Medicare Advantage MSA plans do not include prescription drug coverage.
Special Needs Plans (SNP):
Medicare Advantage Special Needs Plans are for people with special needs, such as those eligible for Medicaid, those with some chronic conditions, or those requiring long-term care in a skilled nursing facility, hospice, or other care settings. These plans provide the necessary support and coverage to help them get the proper care they need, including prescription drug coverage.
How Much Does Medicare Part C Cost?
Private insurers offer Medicare Advantage plans, which determine each plan's monthly premiums and cost-sharing structure (i.e., deductibles, copays, coinsurance).
What you pay for a Medicare Advantage plan depends on several factors: the monthly premium, whether the plan has a deductible, service copays or coinsurance, the type and amount of care needed, and usage of in-network providers. Unlike Original Medicare, Medicare Advantage plans have a limit on the amount of out-of-pocket costs you pay every year.
Remember that to enroll in a Medicare Advantage plan, you must already be enrolled in an Original Medicare plan (both Parts A and B). You'll continue paying 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?
You're automatically enrolled in Original Medicare (Parts A and B) when you first become eligible for Medicare. You can switch to a Medicare Advantage plan during your Initial Enrollment Period (IEP), a seven-month period that begins three months before you turn 65, your birthday month, and the three months after. Around this same time, you should receive your Medicare Card in the mail, which contains your unique Medicare number. This card and number are helpful when you begin enrollment in a Medicare Advantage plan.
If you are outside your IEP, you must wait until the Annual Enrollment Period (AEP) to enroll in a Medicare Advantage Plan. AEP runs from October 15 through December 7 annually.
Because costs and coverage vary by plan, it’s essential to understand each plan’s specific details. Start by researching the Medicare Advantage Plans available in your area using HelloMedicare™’s shopping experience.
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 budget, HelloMedicare™ can also help you enroll in a Medicare Advantage plan. Select “add to cart” on the plan description page to review your choices. Then select “continue to enroll” and have your Medicare Card ready when you begin the enrollment process.
We understand that choosing a plan can be overwhelming. That’s why we are 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 call and ask at +1-855-697-7975, TTY: 711.