Medicare Part C

Medicare Part C, more commonly known as Medicare Advantage, is an alternative to original (traditional) Medicare. While not a program you enroll in through Social Security, it is an optional way to receive your Medicare benefits. These plans are  through private insurance companies that bundle coverage into a single, comprehensive package.

The “Bundled” Plan Concept

Original Medicare consists of two distinct parts: Part A (Hospital Insurance) and Part B (Medical Insurance). Typically, you must purchase a separate Part D plan to cover prescription drugs.

Medicare Part C Streamlines This Process.

When you choose an Advantage plan, it “bundles” Parts A, B, and (almost always) Part D together into one convenient plan. This means you will use one member ID card at the hospital, doctor’s office, and pharmacy. While some Part C plans in limited areas may not include Part D, the vast majority do.

Medicare Advantage plans were developed and created to provide an alternative to Original Medicare and Medicare Supplemental plans. When you join an Advantage plan, you are directing Medicare to pay the Advantage plan a set amount of money for your medical care. The Advantage plan will then cover you for your Part A and Part B services.

Cost & Coverage Breakdown 

One of the main reasons beneficiaries choose Medicare Part C is the cost structure. Medicare Part C plans include a mandatory Maximum Out-of-Pocket (MOOP) limit. Many Medicare Part C plans have no monthly premium, but you will still be required to pay your Medicare Part B premium.

Benefits vary with each Advantage Plan. Each plan will have its own summary of benefits. This summary will allow you to know what your copays will be for your healthcare services. Your plan will offer the same services as Original Medicare, such as doctor visits, surgeries, physical therapy, and so forth.

Additional Benefits

Medicare Advantage plans will offer some additional benefits. Benefits such as routine dental, vision or hearing may be included. When you are deciding on which Medicare Advantage plan is a right for you, we can help you compare the available benefits between plans.

Enrollment & Eligibility Rules

To qualify for a Medicare Part C plan, you must meet the following criteria:
  1. Part A & B Enrollment: You must be enrolled in both Part A and Part B. Dropping Part B will disqualify you from your Part C plan.
  2. Residency: You must reside in the plan’s specific service area (usually your home county).
  3. Timing: You can only join or change plans during specific periods, such as your Initial Enrollment Period when you first become eligible, or the Annual Election Period (Oct 15 – Dec 7), with changes taking effect on January 1st. Special Election Periods may apply in specific circumstances, such as moving.

 

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