What is Medicare Part C (Medicare Advantage)?

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 (which is typically available separately as 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 each 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 15 through December 7 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.

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