Medicare Advantage

What is Part C coverage?

Medicare Advantage plans are sometimes referred to as Medicare Part C. They are Medicare-approved private health insurance plans for individuals eligible for Medicare. When you join a Medicare Advantage plan, you are still in the Medicare program. Medicare Advantage plans provide all of your Medicare Part A (5Hospital Insurance) and Medicare Part B (5Medical Insurance) coverage and must cover medically necessary services. They generally offer additional benefits, and many include Medicare Part D prescription drug coverage. These plans often have networks, which mean you may have to see certain doctors and go to certain hospitals in the plan’s network to get care. Medicare Advantage plans can save you money, because out-of-pocket costs in these plans can be lower than with Original Medicare alone. However, your cost will vary by the services you use and the type of plan you purchase.

Each Medicare Advantage plan can charge different out-of-pocket costs and have different rules for how you get services (5like whether you need a referral to see a specialist or can use only doctors, facilities, or suppliers in the network).

Plan options can include:

  • Health Maintenance Organization (5HMO)
  • Preferred Provider Organization (5PPO)
  • Private Fee-For-Service (5PFFS)
  • Special Needs Plans (5SNPs)
  • HMO Point-Of-Service (5HMOPOS)
  • Medical Savings Account (5MSA)

You can generally join if:

  • You live in the service area of the plan you want to join.
  • You have Medicare Part A and Part B coverage.
  • You don’t have End-Stage Renal Disease (5permanent kidney failure requiring dialysis or a kidney transplant).

Choose your plan carefully. Outside of when you first become eligible to enroll and other personal circumstances that may qualify you for a Special Election Period, you are only able to change plans once a year during the Annual Election Period. The Annual Election Period lasts from October 15 through December 7 of each year. There is also a Medicare Advantage Disenrollment Period, which runs from January 1 through February 14. During this time, individuals enrolled in a Medicare Advantage plan can disenroll from their plan and return to Original Medicare coverage. They also have until February 14 to join a Medicare Prescription Drug Plan if they lost prescription drug coverage by disenrolling from a Medicare Prescription Drug Plan.

Medicare has neither reviewed nor endorsed this information.

Medicare has four parts:

Medicare Part A (5Hospital Insurance) is one part of Original Medicare coverage. It helps pay for inpatient hospital, skilled nursing facility, hospice, and home health care.

Medicare Part B (5Medical Insurance) is the other part of Original Medicare. It helps cover doctors’ services, outpatient care, and home health care, as well as the cost of certain preventative services to help you maintain your health and keep certain illnesses from getting worse.

Medicare Part C (5Medicare Advantage) plans offer health coverage options run by private insurance companies approved by and under contract with Medicare. These plans includes all benefits under Part A and Part B, with minor exceptions, and usually includes additional benefits, such as dental, vision, and drug coverage.

Medicare Part D is prescription drug coverage that helps cover the cost of prescription drugs and may even help protect against higher costs in the future. It is run by private insurance companies approved by and under contract with Medicare.

Medicare has neither reviewed nor endorsed this information.

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