Medicare Part C (Medicare Advantage)

Medicare Part C is most commonly referred to as Medicare Advantage (MA). You can only purchase MA from private insurance companies. MA is a combination of Original Medicare (Parts A and B) and additional benefits like prescription drugs, dental and vision, and fitness programs. It’s a great way for you to combine all the benefits you need into one plan and pay just one premium each month.

Part C Coverage

Part C coverage begins with Original Medicare. You’ll receive coverage for hospital stays, skilled nursing care, home health care (like Part A), doctor visits, outpatient care, and preventative services (like Part B). Some MA plans will then offer additional benefits like hearing care, vision, dental, nurse helplines, and fitness programs. Many MA plans offer SilverSneakers memberships. SilverSneakers is a fitness program for seniors that hosts group fitness classes at various YMCAs and gyms across the country. Medicare Advantage plans also usually include Part D (prescription drug coverage).

Part C Costs

One of the major benefits of Medicare Advantage plans is that all of your costs will be rolled up into one plan with one premium. You’ll need to pay your premium every month, but you’ll only be sending in one check instead of sending different checks for different plans.

Like any other plan, you will be responsible for paying a deductible before your plan begins to cover you. You may be able to find a plan that has a $0 deductible or a low deductible in exchange for a high monthly premium. You will also likely be responsible for copayments when you visit your doctor, hospital, or pharmacy. Copays can range from a few dollars to a few hundred depending on your service. Generally, you’ll be responsible for about 20% of the total cost.

Plan Types

Medicare Advantage plans are highly customizable. There are six types. You may not be eligible for all six, but you will likely have a few options to choose from.

  • HMO Plans (Health Maintenance Organization) – You’ll select one primary physician and will only receive coverage for that one doctor unless he or she recommends that you see a certain specialist (like a cardiologist or dentist).
  • HMO-POS Plans (Point-Of-Service) – You’ll select one primary physician, but you have the freedom to visit any specialist in your network for your other needs. You will be charged a fee for visiting specialists.
  • PPO Plans (Preferred Provider Organization) – You can see any doctor, but your costs will be lower if you choose one that is in your network.
  • PFFS Plans (Private Fee-For-Service) – You will not need referrals or a primary physician, but you’ll have to pick a doctor that accepts your PFFS plan.
  • SNP (Special Needs Plans) – Designed for those who are eligible for both Medicare and Medicaid, live in a nursing home, or have a chronic illness or disability.
  • MSA (Medical Savings Account) – Works like a tax-free savings account for your medical bills. Medicare will deposit money into your HSA. You can use that account to pay for medical expenses.

Part C Enrollment

If you are already enrolled in a Medicare plan but are interested in switching to Medicare Advantage, you’ll have to wait until AEP, the Annual Enrollment Period that occurs every year from October 15 through December 7. Some people will have an exception known as an SEP, or Special Enrollment Period, which allows them to enroll or switch plans during any time of the year.

To find out if you qualify for a special enrollment period or to talk about your other Medicare options, set up a free appointment with one of our licensed agents. Our agents are licensed to sell with multiple carriers, offering you a bias-free approach.

Give us a call at 1-833-255-0113.

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