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Medicare PART C
Medicare Part C
Medicare is a federal health insurance program for individuals 65 and older, or individuals younger than 65 with a disability. The different parts of the federal insurance program include:
- Part A- hospital insurance
- Part B- medical insurance
- Part C- also known as Medicare advantage plans or bundle plans because it encompasses everything you would receive from Parts A and Parts B, as well as prescription drug coverage, vision, dental and hearing benefits.
- Part D- prescription drug coverage
- Supplemental policies known as Medigap – these types of policies pay for what Medicare doesn’t cover.
Part C, Part D, and supplemental policies are parts of Medicare that you receive from private insurance companies that must follow Medicare rules. This guide will discuss Part C in more detail and answer some of the most frequently asked questions.
Medicare Part C Coverage
The type of coverage that you receive from Part C mirrors what you would receive under Part A and Part B such as:
- Inpatient hospital care and nursing facility care
- Doctor visits
- Lab testing
- Mental health services
- DME(durable medical equipment)
- Preventative services, and testing
- Speech therapy, physical therapy, occupational therapy
Unlike Part A and Part B, Medicare Part C includes extra benefit coverages such as:
- Dental care, this could include cleanings, and dentures
- Vision care which would include glasses and contacts
- Hearing care such as hearing aids
- Fitness benefits
Not all Medicare Advantage plans provide the same coverage when it comes to deductibles, copayments, or coinsurance terms, however, they must cover services deemed medically-necessary according to Medicare.
Types of Medicare Advantage Plans
Medicare Advantage Plans combine Original Medicare benefits with additional services, such as vision, dental, and prescription coverage. The plans are offered through private insurance companies that are contracted with Medicare to supply these benefits.
The different types of Medicare Advantage Plan that you can choose from include:
- Health Maintenance Organization Plans (HMOs)- This plan provides you with a network of doctors and hospitals that you must utilize to receive your care, whether it is preventative or emergency. If you use a provider outside the network you must obtain prior approval for it to be covered.
- Preferred Provider Organization Plans (PPOs)- You use a network of doctors and hospitals however you can go outside the network without prior approval by paying a higher copay or coinsurance.
- Private Fee-for-service Plans (PFFs)- This plan allows you to go to any doctor or hospital that is approved by Medicare, the plan determines the dollar amount that is covered based on the services you receive.
- Special Needs Plans (SNPs)- This plan is for beneficiaries that have chronic health conditions or special needs.
- Health Maintenance Organization Point of Service Plans (HMOPOS)
- Medicare Medical Savings Account Plans (MSA)- This plan is a medical savings account where a certain amount is deposited each year to cover your Part A and Part B expenses. This plan does have a high deductible, however, once the deductible is met the plan pays for your services that are covered under Medicare.
Enrolling In A Medicare Advantage Plan
You can enroll in a Medicare Advantage Plan during your initial enrollment period which is the same as when you would enroll in Part B, which is 3 months before your 65th birthday and it ends 3 months after your 65th birthday. This includes the month that you turn 65. Basically, you have 7 months to decide if you want to enroll in a Medicare Advantage Plan.
You can also enroll in a Medicare Advantage plan during annual enrollment. Annual enrollment also referred to as Open Enrollment is from October 15th to December 7th. From January 1st until March 31st is considered a special enrollment period for individuals wanting to switch from a Medicare Advantage plan to Original Medicare.
When You Decide to Enroll
If you choose to enroll in a Medicare Advantage plan, keep in mind that this is voluntary coverage, and not each plan provides the same level of coverage. Before you can enroll in a Medicare Advantage plan, you need to be enrolled in Parts A and B. You should carefully look at each plan before selecting a Medicare Advantage plan. The best way to do this is by requesting assistance with an advisor or can assist you such as those we offer here at the California Health Agency. What is available and covered in one county may not be available in another county, and prices may not even be the same.
Frequently Asked Questions
Here are some frequently asked questions that people have regarding Medicare Part C / Medicare Advantage Plans.
Is Medicare Part C the same as Medicare Supplemental plans?
Medicare Part C is an alternative to Original Medicare. This is different from Medi-Gap or Medicare Supplement plans. Medicare Advantage provides the same benefits as Parts A and B, whereas Medigap covers the expenses that Medicare does not pay for.
How do you choose a Medicare Advantage plan in California?
There are many options to choose from when looking for a Medicare Advantage plan in California. You need to choose a plan that is affordable, and that is tailored to meet your medical needs. You should compare benefits, out-of-pocket costs, and coverage areas. Look at monthly premiums, network restrictions, and it is also important to make sure your current physician is covered within the network, unless you are okay with changing primary providers.
How much does a Medicare Advantage plan cost?
The cost for a Medicare Advantage plan varies based on several factors. This includes where you live, the cost of deductibles, the cost of coinsurance and copayments, as well as the types of coverage that you are selecting. For example some plans may cover routine dental services which can cost more than plans that only cover emergency dental services.
Do I need to enroll in Part D if I enroll in Part C?
Part D is prescription drug coverage which is included when you enroll in most Medicare Advantage Plans. Certain Medicare Advantage plans will disenroll you if you enroll in a stand-alone Medicare Prescription Drug Plan.
Can anyone enroll in a Medicare Advantage Plan?
Advantage plans aren’t for everyone. To qualify for these plans you need to have both Part A and Part B, and you must be in an area that has a provider to service these plans and is currently accepting new enrollments, and you cannot have a renal disease.
If you have any questions about Medicare, please contact us. We’d love to assist you at no charge.
Our Promise To You
At the California Health Agency, every person matters. Your specific needs and situation will be met with care and respect, and we will listen attentively to work with you to ensure you get the care and coverage you need, at the best rate. Health insurance and medicare should be simple. We make sure it is. That is our promise to you.
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