Consolidate Your Coverage with a Medicare Part C Plan
With Medicare Part C, also known as Medicare Advantage, you can have a private health plan while still receiving Medicare benefits.
Medicare Part C allows private insurance companies to sell health plans that provide Medicare benefits. Also known as Medicare Advantage, these plans are regulated by the Medicare program and can keep your medical, hospital and prescription drug needs (based on the plan) under one umbrella. But each plan can vary, so it’s important to make sure it provides the coverage you need before enrolling.
Want to learn more about Medicare Advantage? This guide will break down some important considerations to keep in mind as you shop for a plan.
Original Medicare vs. Medicare Advantage: What’s the Difference?
Medicare Part A is known as hospital insurance. It covers services that are considered medically necessary to treat a disease or condition you may have.
In general, Part A can cover:
Skilled nursing facility care
Nursing home care: Skilled nursing facility
Hospice and respite care
Home health services: Physical therapy, speech-language pathology services
Medicare Part B is known as medical insurance. It covers medically necessary services needed to diagnose and treat a medical condition, and preventive services for common illnesses or help detecting these illnesses at an early stage.
Part B covers:
Outpatient doctor visits
Helps cover ambulance services, including emergency ground transportation, critical access hospital (CAH) and skilled nursing facility when you can’t be safely transported by car or taxi
Durable medical equipment (DME), including canes, oxygen equipment and blood sugar monitors
Mental health services, including inpatient, outpatient and partial hospitalization
Second opinions before surgery to know and understand your treatment options
Limited outpatient prescription drugs under limited conditions
Medicare Part D provides prescription drug coverage. Prescription Drug Plans can be purchased from private health insurance companies and added to Original Medicare. Each plan can vary the amount of coverage it gives to a unique list of covered drugs known as a formulary.
Medicare Advantage (Part C) plans are required to provide the same coverage as Original Medicare and many provide prescription drug coverage. For those looking for these benefits in addition to coverage not typically provided by Original Medicare, Medicare Advantage may be a great option.
To find more information about Medicare Advantage by state, choose your state from the list below:
As mentioned, one highlight of Medicare Advantage is how it can help you save on both monthly premiums and out-of-pocket expenses when you receive care. However, how much you pay for your Medicare Part C plan can depend on a number of factors, including:
Your plan’s monthly premium rate
Your plan’s yearly deductible
Your plan’s copay or coinsurance fees
Your plan’s out-of-pocket maximum limit
If your plan pays for your monthly Medicare Part B premium
What type of service you need and how often you receive them
If you’re seeing a provider that works within your plan’s network
If you’re eligible for subsidies or government assistance
If your Medicare Advantage plan doesn’t cover your Part B premium, you may have to pay two separate premiums each month. However, this can still be a more affordable option than paying for Part A (if you don’t quality for “premium-free Part A”), B, and D individually.
For Medicare Advantage plans, “[Seventy-eight percent of beneficiaries] will have access to zero-premium plans in 2015, though the emphasis on such plans could be declining. The average beneficiary who remains in the same Medicare Advantage plan in 2014 and 2015 will pay $41 per month, an increase of $7 per month, or 20 percent, on average; beneficiaries could avoid higher premiums by changing plans or decide that their current plan still is attractive despite the higher premium,” according to the Kaiser Family Foundation.
Since Medicare Part C plans are available through private health insurance companies, you have options for which type of plans you want to enroll in. These plans can determine which healthcare providers you visit and how much coverage you receive when you seek service from a doctor or specialist in or out of your plan’s network.
There are four types of plans from which you can choose:
Health Maintenance Organization (HMO) plans
Preferred Provider Organization (PPO) plans
Private Fee-for-Service (PFFS) plans
Special Needs Plans (SNPs)
A Medicare Advantage HMO plan requires you to use a specific network of doctors, hospitals and other providers in order to receive your benefits. A primary care physician coordinates your care and provides referrals to specialists when necessary.
These plans usually have lower out-of-pocket costs than PPO plans, and provide coverage for deductibles, a drug benefit plan or wellness programs.
Unlike an HMO plan, Medicare Advantage PPO plan doesn’t limit you to its network of providers. While you can see any doctor you want, it may cost more to see a doctor outside of the network. You also don’t need a referral from a primary care physician. These plans also offer other benefits not included with Original Medicare coverage, like dental and vision care
These plans usually place limits on out-of-pocket expenses on services like emergency and urgent care coverage and prescription drug coverage.
A Medicare SNP is a type of Medicare Advantage plan that limits membership to people with specific diseases or characteristics. The plan is uniquely tailored to their specific benefit needs, choice in providers, and needed drug formulary.
Typically, those enrolled in SNPs must get their health care from in-network doctors and specialists, except for emergency and urgent care. You are required to have a primary care doctor or care coordinator to help with your health care, and you must have a referral to see a specialist.
Depending on your own unique health and budget needs, there’s a type of Medicare Advantage plan that can work for you. Before enrolling, make sure that your plan has the coverage you need for your necessary medical services.
Are You Eligible for Medicare Advantage?
Now that you know about your Medicare Part C options, it’s important to make sure that you qualify for this type of coverage. Before you can even qualify for a Medicare Advantage plan, you must first be eligible for Medicare. Eligibility includes:
Those age 65 years and older
Those younger than 65 years who have certain disabilities
Those with End-Stage Renal Disease (ESRD)
Those with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease)
However, not all Americans who are eligible and enrolled in Medicare may be qualified to join a Medicare Advantage plan. Qualifications for Part C can include:
Enrollment in Medicare Parts A and B
Living in the Medicare Advantage plan’s service area
If you qualify for a Medicare Advantage plan and are ready to enroll, it’s important to understand Medicare’s enrollment periods. While you may be automatically enrolled in Medicare when you become qualified, you must enroll in a Medicare Advantage plan.
You can enroll during specific times of the year, including:
The Initial Enrollment Period when you first become eligible for Medicare
The Annual Enrollment Period when you can change your current plan for a different one
The Special Enrollment Period when specific circumstances occur, such as:
Moving to a new location
Becoming eligible for Medicaid
Qualifying for Extra Help with Medicare prescription drug costs
Getting care in an institution, such as skilled nursing facility or long-term hospital care
With the yearly changes affecting the cost of Medicare, it’s important to make sure you have the most up-to-date information about your benefits and coverage. Our agents are available 24/7 to help you learn about your options.
You can get smart, unbiased help from licensed agents at HealthMarkets. Contact us online or by phone at (855) 839-8126 today.
---------- Sources: “What Part A Covers — Medicare.gov.” 2015. “What Part B covers — Medicare.gov.” 2015. “What drug plans cover — Medicare.gov.” 2015. “Costs for Medicare Advantage Plans — Medicare.gov.” 2015. “Medicare Advantage 2015 Data Spotlight: Overview of Plan Changes — KFF.” 2014. “Different types of Medicare Advantage Plans — Medicare.gov." “Medicare Special Needs Plans (SNP) — Medicare.gov.” 2015. “Original Medicare (Part A and B) Eligibility and Enrollment — CMS.” 2015. “What’s a Medicare Advantage Plan? — Medicare.gov.” 2015. “Understanding Medicare Part C & D Enrollment Periods — Medicare.gov.” 2015.
The Right Coverage at the Lowest Price
Your search for affordable Health, Medicare and Life insurance starts here.
If you are over 65 and don’t have prescription drug coverage, it’s worthwhile to consider getting a Medicare Part D plan. There are thousands of plans with a wide range of premiums and benefits.
Medicare Part C coverage may be the right Medicare choice for you. Also known as a Medicare Advantage plan, Part C combines the coverage of Original Medicare and typically includes Part D to help you maximize your health benefits with one plan.
Medicare coverage is broken into specific parts: Medicare Parts A, B, C, and D. Each part provides its own unique coverage, and depending on which part you choose, the enrollment options will also vary.
On the surface, Medicare parts might look confusing with their generic alphabet names, but don’t worry. Give us less than five minutes, and by the time you finish reading, you’ll be an expert.
Just keep in mind that Medicare is similar to the health insurance coverage you’ve probably had with an employer or individually. It can cover doctor visits, inpatient and outpatient hospital care, prescription drugs, lab tests, etc., and even dental and vision if you like. It’s just broken out a little different than you’re used to.
Here’s a brief overview of each of the parts of Medicare.