August 7, 2019
5 minute read

Consolidate Your Coverage with a Part C Medicare Plan

Medicare_Informational

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.

What’s the Difference Between Original Medicare and Medicare Advantage?

The main difference between Original Medicare and Medicare Advantage is that Original Medicare (Medicare Parts A and B) benefits are administered by the government, and Medicare Advantage (Medicare Part C) benefits are administered by private insurance companies.

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
  • Inpatient care in a hospital
  • Nursing home care (excluding custodial or long-term care)
  • Hospice care
  • Home health services including (but not exclusive of): physical therapy, occupational therapy, and 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, as well as services to prevent or detect common illnesses at an early stage.

Part B can cover:

  • Outpatient medical services
  • Ambulance services, including emergency ground transportation to a critical access hospital (CAH) or skilled nursing facility when you can’t be safely transported by car or taxi
  • Durable medical equipment (DME), including (but not limited to) canes, oxygen equipment, and blood sugar monitors
  • Mental health services, including inpatient, outpatient, and partial hospitalization
  • Second opinions before non-emergency surgery to know and understand your treatment options
  • Limited outpatient prescription drugs under limited conditions
  • Clinical research

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 Medicare) plans are required to provide the same coverage as Original Medicare (Parts A and B). Many Medicare Advantage plans also provide prescription drug coverage, and potentially dental, vision, and hearing coverage.  For those looking for these benefits in addition to coverage not typically provided by Original Medicare, Medicare Advantage may be a great option.

The Cost of Medicare Advantage Plans

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 but not limited to:

  • 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 have Medicaid or receive assistance from your state

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 beneficial option than paying for Part A (if you don’t quality for “premium-free Part A”), B, and D individually.

In 2022, the average premium for a Medicare Advantage with prescription drug coverage will be $19 per month.1 Most Medicare Advantage plans offer prescription drug coverage (89%) with almost two-thirds (65%) of beneficiaries paying no premium for their plan.1 They are only required to pay their Part B premium.

Types of Medicare Advantage Plans

Since Part C Medicare 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 and lower monthly premiums than PPO plans, and may even have no deductible.

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 often offer benefits not included with Original Medicare 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 insurance 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.

Who Is Eligible for Part C Medicare?

You may be eligible for Part C Medicare if the following applies:

  • Enrollment in Medicare Parts A and B
  • Residence in the Medicare Advantage plan’s service area

So, before you can even qualify for a Medicare Advantage plan, you must first be eligible for Medicare.

You may be eligible for Medicare if one or more of the following applies to you:

  1. ·You are 65 or older
  2. You have a disability and have been on Social Security benefits for two years
  3. You have end-stage renal disease (ESRD) or Lou Gehrig’s disease

Can You Add Medicare Part C at Any Time?

No, you cannot add Medicare Part C at any time. 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 actively enroll in a Medicare Advantage plan.

You can enroll during specific times of the year, including: 

  1. The Initial Enrollment Period when you first become eligible for Medicare
  2. The Open Enrollment Period (October 15 – December 7) when you can change your current plan for a different one
  3. The Medicare Advantage Open Enrollment Period (January 1 – March 31) when you can switch to another Medicare Advantage plan or return to Original Medicare.
  4. The Special Enrollment Period when specific circumstances occur, including (but not limited to):
    • Moving to a new location
    • Becoming eligible for Medicaid
    • Qualifying for Extra Help">Extra Help with Medicare prescription drug costs
    • Getting care in an institution, such as skilled nursing facility or long-term care hospital

Is Medicare Part C Being Discontinued?

No, Medicare Part C is not being discontinued. However, there are other types of plans that may be sold by private insurance companies to help fill “gaps” in Original Medicare called Medicare Supplements or Medigap plans. As of January 1, 2020, Medigap Plan C is not available to those who are new to Medicare. 

How Do I Apply for Medicare Part C?

You can apply for Medicare Part C a number of ways, including (but not limited to) visiting the plan’s website, filling out a paper enrollment form, or calling the plan’s phone number. Additionally, HealthMarkets can help you compare Medicare Advantage plans online and begin the application process.

With the yearly changes affecting the cost of Part C Medicare, it’s important to make sure you have the most up-to-date information about your benefits and coverage. HealthMarkets can consider your unique insurance needs to help you find the right Medicare Part C plan, at no cost to you. Get started comparing plans online today, or call (888) 986-2752 to speak to a licensed insurance agent.

MULTIPLAN_HMPARTC_2022_M

References:
1. “Medicare Advantage 2022 Spotlight: First Look.” KFF. November 2021. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-2022-spotlight-first-look/

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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1- 844-704-7357), 24 hours a day/7 days a week, to get information on all of your options.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

© 2022 HealthMarkets Insurance Agency. All rights reserved.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1- 844-704-7357), 24 hours a day/7 days a week, to get information on all of your options.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

© 2022 HealthMarkets Insurance Agency. All rights reserved.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1- 844-704-7357), 24 hours a day/7 days a week, to get information on all of your options.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.