Medicare Part C

Medicare Part C

Medicare Part C, also known as Medicare Advantage, is a type of Medicare plan that offers the same coverage as Original Medicare and is sold by private insurers contracted with Medicare. Many Part C plans also provide additional coverage for other services, such as prescription drugs, dental, vision, and hearing care.

Eligibility and Enrollment

To enroll for Part C, you must be enrolled in Original Medicare and must live within your plan’s service area. To be eligible for Original Medicare, you must be 65 years or older or meet other qualifying requirements if you are younger than 65, such as having a qualifying disability and receiving disability benefits.

You can typically enroll in a Part C plan during the Annual Enrollment Period (October 15 – December 7), which is where you can make any necessary changes to your coverage and plan. You can also enroll during the Medicare Advantage Open Enrollment Period (January 1 – March 31).

To stay enrolled in a Part C plan, you must continue to pay your Part B premiums and other costs associated with Medicare Advantage. However, some Part C plans may help cover a part of your Part B premium.

Types of Part C Plans

There are various types of Part C plans. There are Part C HMOs, PPOs, PFFS, MSAs, and SNPs. Each plan has its distinct features.

  • HMO: Health Maintenance Organization plans often have a specific network of providers that are within the policy’s coverage. Beneficiaries are always encouraged to go to these providers for medical care. Going outside this network can result in expensive out-of-pocket costs.
  • PPO: Preferred Provider Organization plans provide more flexibility than HMO plans, as they allow enrollees to visit out-of-network providers. Though there is an approved network of providers, you can get coverage outside the network. You do not need referrals for specialist visits, nor do you need to select a primary care physician.
  • PFFS: With Private Fee-For-Service plans, you can visit any provider that accepts this plan’s terms. You do not need to choose a primary care doctor or get referrals for specialist visits.
  • SNPs: Special Needs Plans are tailored for specific individuals with certain chronic conditions that may require certain healthcare services. There are three types of Special Needs Plans you can be eligible for: Dual-Eligible (D-SNP), Chronic-Condition (C-SNP), and Institutional (I-SNP).
  • MSA: MSA Plans have a high-deductible structure. For your policy to pay for medical expenses, your deductible for the year will need to be met. MSA Plans deposit money into the savings account, and that money can be used to cover medical expenses before you meet your deductible.

What Does it Cover?

Medicare Part C covers all healthcare services covered under Original Medicare, such as skilled nursing facility care, home health care, preventive screenings, ambulance rides, doctor visits, etc. Many Part C plans also provide coverage for prescription drugs, dental, hearing, vision, and other benefits such as gym memberships and transportation to doctor visits.

If you are interested in enrolling or becoming eligible for a Part C plan, give us a call today at (775) 328-1197.