Medicare Part C – Medicare Advantage Plan

January 13, 2021 13:08 newlambertagency

Medicare part C is part of the 4 basic Medicare. Also known as Medicare Advantage Plan (like an HMO or PPO), Part C is an alternative way to get your Original Medicare coverage.

While Medicare Part C covers the same benefits as Medicare Part A including Inpatient care in a hospital, it also includes home health care.

There are 4 types of Medicare Advantage Plans:

  • Health Maintenance Organization plans (HMOs)
  • Preferred Provider Organization plans (PPOs)
  • Special Needs Plans (SNPs)
  • Private Fee-for-Service plans (PFFS)

Some plans under Medicare Part C require you to see in-network providers to qualify for coverage while others might let you see out-of-network providers with less coverage. It’s always better to choose in-network doctors if you decide to enroll in this plan.

The Benefits

With exception of hospice care, Part C includes your Part A and Part B benefits. Many Medicare Advantage plans offer additional coverage beyond Original Medicare. Some of those benefits might include:

  • Routine dental care
  • Routine vision services
  • Routine hearing services
  • Wellness programs called SilverSneakers
  • Prescription medications

Besides the aforementioned benefits, Part C also offers additional benefits today, such as over-the-counter medications, transportation to and from doctor appointments, and adult day-care services.

The Cost

Part C plans may have different costs – some plans charge a monthly premium before enrollment, while they can also have an annual deductible, which is an amount you pay out of pocket before your coverage starts.

There are also plans with $0 premiums and $0 deductibles.

Medical services may require you to pay a copay (a set amount you pay at every visit) or coinsurance (percentage of the total bill)

It is important to compare plans in your service area carefully since costs and coverage can be different from plan to plan. This step will ensure you get all the coverage you need at a cost that fits with your monthly budget.

Enrolling in Medicare Part C

Enrollment in a Medicare Part C plan can be done at different times of the year. First is the Initial Enrollment Period (IEP). This is the period when you first become eligible for Medicare. This enrollment period begins three months before the month you turn 65.

The second opportunity to enroll is during the Fall Open Enrollment Period (OEP), which runs from October 15 to December 7 each year. During the Fall OEP, you can switch from Original Medicare to a Medicare Advantage plan. You can also change from one Medicare Advantage plan to another.

The third time is from January 1 to March 31, during which, you can switch from one Medicare Advantage plan to another. However, you cannot change from Original Medicare to a Medicare Advantage plan during this enrollment period.