Medicare Part C: What You Should Know about Medicare Advantage Plans

What is Medicare Part C?

Medicare Part C is an alternative to Original Medicare, which is offered by the federal government. These plans are offered and managed by private insurers approved by Medicare.

Medicare Advantage is another name for Medicare Part C combining the hospital and doctor coverage of Medicare Parts A and B into one plan, often with extra benefits like routine dental, vision and hearing care. Many Medicare Advantage plans also include prescription drug coverage (Medicare Part D). Medicare Advantage plans also offer the protection of an annual limit on out-of-pocket costs that Original Medicare does not offer, though this limit varies by plan.

Medicare Advantage eligibility is based on your eligibility for Original Medicare. If you're enrolled in Medicare Part A and Medicare Part B, you are typically eligible for a Medicare Advantage plan. You must also live in the area that the Medicare Advantage plan services.

What Does Medicare Part C Cover?

A Medicare Advantage plan (i.e., Medicare Part C coverage) is required to provide all the hospital and medical benefits included in Original Medicare. The only exception is hospice care, a benefit covered by Medicare Part A.

Most Medicare Advantage plans offer additional benefits beyond what Original Medicare provides. These include routine dental, vision, and hearing care, health club memberships, wellness services, and even coverage for acupuncture, pest control, and grocery store transportation. Many Medicare Advantage plans include prescription drug coverage (Medicare Part D).

Another difference between Original Medicare and Medicare Advantage is the presence of provider networks. Original Medicare allows you to see any Medicare-approved provider without restrictions. In contrast, Medicare Advantage plans require using in-network providers, including doctors, hospitals, pharmacies, and other healthcare providers.

There are several types of Medicare Advantage plans:

Health Maintenance Organization plan (HMO):

A Medicare Advantage HMO plan allows you to see healthcare providers who participate in the plan's approved provider network. If you're considering a Medicare Advantage HMO plan, it's a good idea to check if your preferred doctors and providers are in the plan network. HMO plans typically only cover providers in the plan network. You'll also typically need a referral to see a specialist.

Point-of-Service plans (POS):

These plans have all the benefits of an HMO plan but with more provider choices. A POS plan covers both in-network and out-of-network services. However, you'll typically pay less when using an in-network provider.

Preferred Provider Organization plan (PPO):

A plan that covers both in-network and out-of-network providers. Unlike Medicare Advantage HMO plans, you don't need a referral to see a specialist. These plan premiums are generally higher than HMO or POS plan premiums.

Private Fee-for-Service plan (PFFS):

Insurance companies offering Medicare PFFS plans determine how much they will pay providers and how much you will pay when receiving care. Your provider must accept the plan's payment terms to cover your services. These plans may or may not have provider networks.

Medical Savings Account plan (MSA):

A plan that combines a high deductible with a special savings account to help you save for that deductible. The money saved in the account is tax-free if used on IRS-qualified medical expenses, including the plan's deductible. With this plan, you can see any provider of your choice. Medicare Advantage MSA plans do not include prescription drug coverage.

Special Needs Plans (SNP):

Medicare Advantage Special Needs Plans are for people with special needs, such as those eligible for Medicaid, those with some chronic conditions, or those requiring long-term care in a skilled nursing facility, hospice, or other care settings. Special Needs Plans include care coordination services and tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve.

How Much Does Medicare Part C Cost?

Private insurers offer Medicare Advantage plans, which determine each plan's monthly premiums and cost-sharing structure (i.e., deductibles, copays, coinsurance).

What you pay for a Medicare Advantage plan depends on several factors: the monthly premium, whether the plan has a deductible, service copays or coinsurance, the type and amount of care needed, and usage of in-network providers. Unlike Original Medicare, Medicare Advantage plans have a limit on the amount of out-of-pocket costs you pay every year.

Remember that to enroll in a Medicare Advantage plan, you must already be enrolled in an Original Medicare plan (both Parts A and B). You'll continue paying your Medicare Part B premiums to remain eligible for your Medicare Advantage plan.

When and How Can I Sign Up for Medicare Part C?

You're automatically enrolled in Original Medicare (Parts A and B) when you first become eligible for Medicare. You can switch to a Medicare Advantage plan during your Initial Enrollment Period (IEP), a seven-month period around your 65th birthday. Your IEP begins three months before your 65th birthday (four months if your birthdate is the 1st of the month) and extends 3 months after your birthday (two months if your birthdate is the 1st of the month). Around this same time, you should receive your Medicare Card in the mail, which contains your unique Medicare number. This card and number are helpful when you begin enrollment in a Medicare Advantage plan.

If you are outside your IEP, you must wait until the Annual Open Enrollment Period (AEP) to enroll in a Medicare Advantage Plan. AEP runs from October 15 through December 7 annually.

When you find a plan that fits your healthcare needs and budget, HelloMedicare® can also help you enroll in a Medicare Advantage plan. When you are ready to enroll, we recommend you have your Medicare Card ready when you begin the enrollment process.