Medicare Part C

Medicare Part C is also called Medicare Advantage. The Medicare Advantage program consists of a variety of plans offered by private insurance companies. Many of these plans are premium-free, which makes them very attractive to Medicare beneficiaries. It’s important to understand both the pros and cons of Medicare Advantage plans.

What is

Medicare Part C?

Cartoon artwork explaining Medicare Part C

Part C plans offer “all-in-one” Medicare coverage. They bundle the benefits from Parts A and B and have additional benefits. If an individual enrolls in a Part C plan, the benefits are all provided by the private insurance company instead of the federal Medicare program.

What is Medicare Part C?

There are several types of Medicare Advantage plans. The two most common are Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans. HMOs often come with a $0 premium, but only offer coverage if the member receives care from a doctor within the HMO network. PPO plans may have a higher premium, but does offer coverage even outside of the PPO network. There are also Private Fee-for-Service (PFFS) Medicare Advantage plans. These plans require their members to call their provider prior to treatment to make sure coverage is still available through that provider or facility. Finally, there are also Special Needs Plans (SNPs). These Part C plans are for individuals with low-income or chronic conditions. Like HMOs, you must live in the plan’s service area to qualify for this type of Medicare Advantage plan.

Medicare Part C Benefits

A Medicare Advantage plan must offer coverage of all services that would be covered under Medicare Parts A and B. However, most Medicare Advantage plans include additional coverage for things like routine dental, vision, and hearing benefits. Many of them also include prescription drug coverage and over-the-counter medication benefits, though you should inquire about the specific plan’s drug formulary. The drug formulary includes the list of prescriptions covered under the plan and how much each drug will cost the member. Most Advantage plans offer transportation assistance and meal delivery, as well as gym memberships. Some include the Part B reduction benefit, which reduces the amount the member pays for their Part B premium. Few Part C plans now include long-term care coverage. While all of these benefits make Medicare Advantage plans seem like the obvious choice, you should still talk to one of our licensed agents before making this decision.

Medicare Part C Eligibility

Medicare beneficiaries must already be enrolled in Original Medicare to be eligible for Part C. These plans do not require medical underwriting, so nearly everyone is eligible to enroll. However, those with End-Stage Renal Disease are not eligible for a Medicare Advantage plan. If an individual develops ESRD while enrolled in a Medicare Advantage plan, they may be able to select a different plan with the same carrier. If that plan leaves the service area, the individual will have a one-time right to choose another Medicare Advantage policy.

How does Medicare Part C differ from Original Medicare?

Original Medicare does not have provider networks. Individuals enrolled in Original Medicare can choose to see any provider who accepts Medicare assignment in the United States. Medicare Advantage plans have a list of in-network providers that the member must choose from. Receiving care outside the network could leave the member paying for all costs out-of-pocket, except for in emergency situations. Individuals will need to compare their Medicare Advantage plan choices to those offered by Medicare supplements.

How much does Medicare Part C cost?

There are many Part C plans that offer coverage for a $0 premium, but the average cost is approximately $23 per month. Of course, there are other costs associated with Part C plans like copays and coinsurance. These costs vary by plan. Individuals who live in areas with limited Part C options should consider purchasing a Medicare supplement plan instead.

Reinstating Medicare Advantage Plan Coverage

Plans with a Single Grace Period may disenroll individuals who miss one or more premium payments. Plans that have a Rollover Grace Period allow their members to stay enrolled if they owe more than one month’s premium but pay for at least one premium during the grace period. If this occurs, a new grace period will begin. Insurance companies will send notifications to members who have failed to pay their premiums, but will disenroll any member who fails to make a payment during the grace period. Once an individual has been disenrolled from a plan, they will have to submit an application for coverage.

Enrollment into

Medicare Part C

Individuals who are considering enrollment in a Part C plan must already be enrolled in Medicare Parts A and B. After that, beneficiaries should seek the help of one of our licensed agents to make sure that a Part C plan is the best option.

We will ask you questions to understand your unique situation, and then look at the plans offered in your service area. We can even help you decide if you would benefit more from a Part C plan or a Medicare supplement plan.

Questions to be advised on:

The Missouri Medicare Advisor website character Julian Chambers discussing Questions to be advised on.
Medicare Advantage plans must be approved by the Medicare program. If approved, the insurance companies who offer the plans receive funding from the government. This allows the insurance companies to offer lower rates for premiums.
No, Medicare supplement plans offer more comprehensive medical coverage, but do not include any benefits not already covered by Original Medicare.
No, enrollment in Medicare Part C is not required. However, choosing either Part C or a Medicare supplement will lower your out-of-pocket expenses for healthcare.
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