Medicare Part C

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Medicare Part C in 2019 & 2020 

What it covers: Private Insurance

Medicare Part C plans are often called Medicare Advantage Plans. These are are private insurance plans for people who are already enrolled in Medicare Part A and Part B plans. These plans have have to follow Medicare rules and are all pre-approved by Medicare.

Medicare Advantage plans provide all of your Medicare Part A (hospital insurance) and Medicare Part B (outpatient insurance) coverage. They generally offer other benefits, too, such as vision, dental, and hearing, and usually include prescription drug coverage through Medicare Part D.

Medicare Part C plans can potentially lower out-of-pocket costs and save you more money than with Medicare Part A and Part B. Since Medicare Advantage plan benefits, premiums and costs vary substantially, you’ll want to do research to find the plan that best fits your needs.

Each Medicare Advantage plan may charge different out-of-pocket costs and have different rules for using services. For example, if you need a referral to see a specialist, or can use only doctors, facilities, or suppliers in the network).

Medicare Part C coverage can include any of the following types of medical services delivery:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-for-Service (PFFS)
  • Special Needs Plans (SNPs)
  • HMO Point-of-Service (HMOPOS)
  • Medical Savings Account (MSA)

Who does it cover

You are have Original Medicare when you join a Medicare Advantage plan and must continue paying your Part B premium. Medicare, in turn, pays a fixed amount for your care every month to the insurance company that is providing your Medicare Advantage Plan.

When You Can Enroll

Outside of when you are first eligible to enroll, you are usually able to change plans only once a year during the Annual Election Period. The Annual Election Period lasts from October 15th through December 7th of each year. To join Medicare Part C you have to be a part of Medicare Part A and Medicare Part B, but you cannot have end stage renal disease.

What Does Medicare Part C (Medicare Advantage) Cost?

They can structured as Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), as well as in many other ways. Since the Medicare Advantage Plan benefits are unique to each plan, premiums and costs vary substantially. You’ll want to do research to find the plan in your area that best fits your needs. As a holder of Medicare Part C plan you must continue paying your Medicare Part B premiums. Medicare Part C policies provides the same benefits as Medicare Part A and B policies, but can also cover vision, dental, hearing, and prescription drugs. Policy prices vary by area providers and the type of policy chosen.

Who is Eligible for Part C

While enrollment in Medicare Parts A and B are often automatic for those that qualify for premium-free coverage, enrollment in Medicare Part C is voluntary.

You must have Medicare Part A and B to get a Medicare Part C (Medicare Advantage Plan). This means that if you have been collecting Social Security or RailRoad Retirement Board Retirement benefits for at least 10 years and turned 65.

In most cases, you cannot join Medicare Part C if you have an End Stage Renal Disease.

Will all Doctors accept Medicare Advantage Plans?

Unlike original Medicare (Parts A and B) where any doctor or hospital that accepts Medicare will take you in, Medicare Advantage plans can only be accepted by doctors or hospitals that are within a given plan’s network. Before committing to a plan, ask your current doctor if they accept any Medicare Advantage plans and which ones. To avoid the uncertainty of finding a new medical provider that covers your medical plan, you may want to find a plan that works with your current medical provider.

To see a specialist, you may also need a referral from Medicare and your doctor if you are under a Medicare Advantage plan.

Finding a Plan

Comparing plans can be a bit of a hassle and requires some time and research. Some plans may specifically be covered only in certain areas or with certain doctors or medical providers. 

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Who Signs Up

While enrollment in Medicare Part A is often automatic for those that qualify for premium-free coverage, enrollment in Medicare Part C is voluntary.

You must have Medicare Part A and B to get a Medicare Part C (Medicare Advantage Plan).

In most cases, you cannot join Medicare Part C if you have an End Stage Renal Disease.

Where to Sign Up

Once you choose a Medicare Part C plan, you can enroll on on the plan’s website, or you can call the Medicare number at 1-800-MEDICARE (1-800-633-4227).

When you join a Medicare drug plan, you’ll need to give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.

When To Sign Up

You can sign up for Medicare Part C coverage during the Initial enrollment Period or the Annual Election Period, or Special Election Period.

  • Initial Enrollment Period

    Begins three months before your 65th birthday and is seven months long

  • Annual Enrollment Period

    Takes place from October 15th to December 7th every year

  • Special Election Period

    Enables you to enroll in Part D plans if you have a qualifying life event such as moving outside your current plan’s service area

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