MEDICARE PART C (Advantage Plans)
Medicare Part C is also known as Medicare Advantage or MA plans. Contrary to popular belief, Part C is not part of Original Medicare. To be exact, it is a private insurance plan. Part C was created as a result of The Balanced Budget Act of 1997. Private insurance companies offer Advantage plans as an alternative to traditional Original Medicare.
Part C is similar to health insurance coverage you may have had in the past. This could have been through either an employer or through individual coverage. Like employer plans, many advantage plans are comprehensive. They bundle together Part A or hospital insurance and Part B or medical insurance. They oftentimes include Part D or prescription drug insurance.
What types of Medicare Part C Plans are available?
Medicare Advantage plans are available in the form of HMO (Health Maintenance Organizations) and PPO (Preferred Provider Organizations) plans.
- HMO plans have a network of providers. The plan typically does not cover providers outside of the network. In addition to this, you will choose a PCP or primary care doctor. Your PCP will direct your care. If you need to see a specialist, you will likely need a referral from your PCP.
- PPO plans also include a network of providers. In contrast to HMO plans, you usually are not required to choose a PCP. Also, you may or may not need a referral to see a specialist. If you would like to see a doctor outside of the network, you may usually do so for an additional cost.
Who handles Medicare Part C Claims?
Medicare Advantage plans replace Original Medicare. This means that Medicare will not handle your insurance claims. Instead, the primary payer is the insurance company. Therefore the insurance company will manage your Medicare Part A and Part B.
What do Medicare Part C plans cover?
Under federal law, Medicare Advantage plans must provide at least the same coverage as Original Medicare. Not only this, but CMS (the Centers for Medicare and Medicaid Services) also allows Medicare Advantage to offer additional benefits outside of what Medicare covers.
For example:
- Dental
- Vision
- Hearing
- Prescription Drugs
- Health and Wellness programs
- Gym Memberships
- Wheelchair ramps
- Meal Delivery
- Transportation to and from doctors’ offices and pharmacies
- Over The Counter benefits
Many Medicare Advantage plans include prescription drug coverage. These are also known as MAPD plans. It is important to note that every Medicare Advantage plan is different. Therefore, Advantage plans may include some or all of these extra benefits.
How much does a Medicare Part C plan cost?
Even if you have a Medicare Part C plan, you will still pay the Part B premium each month. For most people in 2022, this premium is $179.10 per month. The federal government pays your premium to the private insurance company that handles your plan. In addition to this, they pay that insurance company a fixed amount.
CMS sets certain rules and criteria. Therefore insurance companies must follow these rules. As previously mentioned, they must cover at least the same services that Original Medicare covers. However, the plans can implement different out-of-pocket costs. They can also change the rules for how you receive these services. For example, you may need a referral to see a specialist under a Medicare Advantage plan. Conversely, if you are on Original Medicare no referral is needed. Understand that private insurance companies can and often do change these plans every year.
Medicare Part C plans typically have very low premiums. Although the premiums are usually low, Advantage plans have co-pays, co-insurances, and deductibles. Because of this, a Supplement plan may be more cost-effective in the long-run. To determine which option is best for you, read my post about choosing a Medicare Supplement or Medicare Advantage plan.
Each year, the government sends a Medicare & You guidebook to eligible Medicare recipients. This guidebook provides a chart of all of the available Advantage plans based on your area. If you cannot find your copy, you can order a new one by calling 1-800-MEDICARE.
In addition to this, you may also visit https://www.medicare.gov/. Once you are there, click on “Find Plans”. From here you can compare available Medicare Advantage plans and Part D plans. You can also base your comparison on your pharmacy and medications.
When can I enroll in Medicare Part C?
Enrollment during IEP
Similar to Original Medicare, you are eligible to enroll in Medicare Part C during your Initial Enrollment Period (IEP). This is a 7-month period. It includes the three months before the month of your 65th birthday, the month of your 65th birthday, and up to three months after the month of your 65th birthday. For an example, read my post about Medicare Part B.
Enrollment during AEP
If you are not in your initial enrollment period and wish to enroll in Part C, you may do so during the annual enrollment period (AEP) which is every year from October 15th-December 7th.
Enrollment during SEP
You may also enroll during special circumstances that qualify you for a special enrollment period (SEP).
How to qualify for Part C
In order to enroll in Medicare Part C, you must first enroll in Part A and Part B. After this, you may wish to contact an insurance agent or broker. A good broker will go over your options as well as help you enroll in your plan.
Compare your Medicare plan options
Remember, you are not required to enroll in Part C. As an alternative, you may choose a Medicare Supplement plan. This is also referred to as a Medigap plan.
To learn more about these two coverage options and which option is best for you, read my article about choosing a Medicare Advantage or Medicare Supplement plan.
Contact Us
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Our office is located in Honolulu, HI and licensed in multiple states. We offer our services by appointment in person, over the phone, or by video call. We look forward to helping you!