Medicare Part C, sometimes called “Medicare Advantage” or “MA,” is offered by private insurance companies approved by Medicare. Medicare pays these companies to cover your Medicare Part A and B benefits.
Medicare Part C must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Part C plan. In all types of Part C plans, you’re always covered for emergency and urgent care. Depending on your area, Part C plans may also offer extra benefits, such as:
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Fitness & Wellness
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Telehealth
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And maybe more!
Medicare Made Easy Part Three: Medicare Advantage Plans
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What are the Perks of Medicare Part C? (Medicare Advantage)
Bundled Coverage
Medicare Part C can help you bundle your coverage so that instead of having Original Medicare and multiple stand-alone plans for prescriptions, vision, or dental care, all that coverage flows through one plan instead.
Cost Savings
Many Medicare Part C plans offer premiums, deductibles, and copays as low as $0. Depending on your current coverage and the Medicare Advantage Plans available in your area, an MA plan may be able to save you money on healthcare costs.
Maximum Annual Out of Pocket Limit
With Medicare Part C, you will have a maximum out-of-pocket limit on health costs for yearly spending. Once you have reached that limit, covered services will cost you $0. All plans are different and change on a yearly basis, so make sure you do your research before choosing a plan.
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Types of Medicare Part C (Medicare Advantage)
Here are the different types of Medicare Advantage Plans:
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Health Maintenance Organizations (HMOs)
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Preferred Provider Organizations (PPOs)
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Private Fee-For-Service (PFFS)
Other options include HMO Point-of-Service (HMO POS) and Medical Savings Account (MSA) plans.
Not all Medicare Advantage plans are the same. It is important to always research the costs and benefits of each plan. Make sure to consider the medications that you are taking. Some Medicare Part C plans cover prescription drugs, while others do not.
A licensed health insurance agent can help you find and compare Medicare Advantage plans in your area so you find the benefits that are important to you, understand your likely costs or savings under the plan, and know whether your providers are in-network. They can also help you enroll in the plan of your choice.
Medicare Advantage (Part C) Eligibility
When it comes to Medicare Part C eligibility, you must have Medicare Parts A and B and live in the plan’s service area. You will have options for Medicare Advantage Plans and you may be able to join certain Special Needs Plans, like a Chronic Condition Special Needs Plan (C-SNP).
Enrollment for Medicare Part C is not open at all times, but you may be eligible to enroll if you have recently obtained Medicare Parts A and B, if you have recently lost health coverage, or if it is the Medicare Annual Enrollment Period (Oct. 15 – Dec. 7).
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Enrollment Eligibility
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
Special Enrollment Period (SEP)
You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.
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