Medicare Part C

Medicare Part C

Part C is also known as Medicare Advantage plans. These are plans approved for individuals who enrolled into Medicare Part A and also Part B. You will essentially need paying your Medicare Part B premium during the time you have joined the Medicare Advantage plan. You will get a total coverage of hospital insurance (Part A) and medical insurance (Part B) within your Medicare Part C plan. Plus, there are additional benefits like your dental, vision, hearing and prescription drugs are all covered in the plan.

Medicare part A

There are in-network benefits within this plan, just like PPO or POS. You will have a lot of facilities if you visited your doctors who are in-network of your plan. You may save a lot of money with Medicare Part C as the out-of-pocket costs are lesser than Part A and Part B. You may opt for plans like:

  • Health Maintenance Organization (HMO)
  • HMO Point-Of-Service (HMOPOS)
  • Special Need Plans (SNPs)
  • Private Fee-For-Service (PFFS)
  • Preferred Provider Organization (PPO)

Before you get into buying Medicare Part C, you must understand the different types of Medicare Part C (Advantage) plans for you, and which one will work best:

HMO- This plans allows you to see your doctor and different other health care providers who are specifically working within your network. In case your doctor is within your network, it will be an excellent option as you will ultimately pay less out-of-pocket when you show to in-network doctors.

HMO-POS- This plan will cover both in-network within your HMO plan and Out-of-network within your POS plan. As two different plans have been covered together, you pay much less even if you choose out-of-network or in-network plans.

SNPs- These plans are for people with special needs . Different SNP plans are there that cover beneficiaries of Medicare living in different institutions, who are dual-eligible- both for Medicare and Medicaid. There are also plans in SNP for people with chronic diabetes, ESRD (end stage renal disease), and HIV. This plan will always include prescription drug in its coverage.

PFFS- This plan calculates how much coverage it will give to its enrollees and how much you need to pay to receive care. The doctor treating you will have to agree the amount plan is paying for your treatment. In case the doctors disagrees, the PPFS will not cover its plan through that doctor and look for another doctor.

PPO- PPO will cover about out-of and in-network plans. It gives you the freedom to choose any doctor who will accept your Medicare plan, and will work if you are ready for that kind of flexibility.

Are you eligible for Medicare Part C Plans

Whether you are eligible for Medicare Advantage Plan depends on your eligibility towards Medicare Original (Part A and Part B), with the only exception of you having ESRD. General cases allow you eligibility for Part C if you are eligible for Part a and Part B. However, you have to live within the service area for the Medicare plan you planning to buy.

In case you are eligible for other plans like Employer-based plan or Group Health Insurance Plan, seek explanation for your planner about the rules whether you can be eligible for Medicare Advantage.