Medicare Part C

Medicare Part C (like an HMO or PPO) is another health coverage choice you may have as part of Medicare.

Medicare Advantage Plans, sometimes called Medicare Part C or MA Plans, are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage. In all plan types, you’re always covered for emergency and urgent care.

Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. Medicare Advantage Plans aren’t considered supplemental coverage.

Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage. In addition to your Medicare Part B premium, you usually pay one monthly premium for the services provided.

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services, for example, whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan.

Medicare Advantage Plans include the following:

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Medical Savings Account (MSA) Plans
  • Special Needs Plans (SNP)

Make sure you understand how a plan works before you join. Not all Medicare Advantage Plans work the same way, so before you join, find out the plan’s rules, what your costs will be, and whether the plan will meet your needs.

More About Medicare Advantage Plans

As with Original Medicare, you have Medicare rights and protections, including the right to appeal.

  • Check with the plan before you get a service to find out whether they will cover the service and what your costs may be
  • You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs; check with the plan
  • You can join a Medicare Advantage Plan even if you have a pre existing condition, except for End-Stage Renal Disease
  • You can only join a plan at certain times during the year
  • If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan
  • If the plan decides to stop participating in Medicare, you’ll have to join another Medicare health plan or return to Original Medicare

You can join, switch, or drop a Medicare Advantage Plan at these times:

  1. When you first become eligible for Medicare (the seven month period that begins three months before the month you turn age 65, includes the month you turn age 65, and ends three months after the month you turn age 65).
  2. If you receive Medicare due to a disability, you can join during the three months before to three months after your 25th month of disability. You’ll have another chance to join three months before the month you turn age 65 to three months after the month you turn age 65.
  3. Between November 15–December 31 each year. Your coverage will begin on January 1 of the following year, as long as the plan receives your enrollment request by December 31.
  4. Between January 1 – March 31 of each year. Your coverage will begin the first day of the month after the plan gets your enrollment form. During this period, you can’t do the following:
  5. Join or switch to a plan with prescription drug coverage unless you already have Medicare prescription drug coverage (Medicare Part D).
  6. Drop a plan with prescription drug coverage.
  7. Join, switch, or drop a Medicare Medical Savings Account Plan.

In most cases, you must stay enrolled for that calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan at other times. Some of these situations include the following:

  • If you move out of your plan’s service area
  • If you have both Medicare and Medicaid
  • If you qualify for Extra Help to pay for your prescription drug costs
  • If you live in an institution (like a nursing home)

Call your State Health Insurance Assistance Program (SHIP) for more information.

Call us (215) 738-8100 or send us a message!

3 + 1 =

Medicare Insurance Blog

Finding a Medicare Broker or Medicare Agent

Find a Medicare Broker or Medicare Agent Find a Medicare Broker or Medicare Agent. For many people turning 65 there is plenty of confusion as to what they need to do for their Medicare Health Insurance. Many people are used to and familiar with their employer...

What are the best Medicare Supplements in Pa

What are the best Medicare Supplements in Pa What are the best Medicare Supplements in Pa is a question that is often asked. There are several different options that need to be considered. One of the first considerations is which one of the 10 Standardized Medicare...

Kaiser Health News

RSS Syndicate – Kaiser Health News

  • Podcast: KHN’s ‘What The Health?’ Nothing In Health Care Ever Goes Away April 19, 2018
    In this episode of KHN’s “What the Health?” Sarah Jane Tribble of Kaiser Health News, Joanne Kenen of Politico, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post examine how even after Republicans failed to repeal and replace the Affordable Care Act, the health care debate continues to roil […]
  • New Medicare Perk For Diabetes Prevention Stumbles At Rollout April 19, 2018
    On April 1, Medicare launched a major initiative — a diabetes prevention program for seniors and people with serious disabilities— that is available in only a few cities.
  • Applying Silicon Valley Smarts To Age-Old Diseases April 19, 2018
    Customized iPhones are just one example of devices that can be used to combat health threats in developing countries. They are helping scientists in California and Cameroon attack the parasite that causes river blindness, an African scourge.

Medicare Updates

RSS The Medicare Blog

  • Rethink drinking April 9, 2018
    As you get older, alcohol may start to effect you differently. You may become more sensitive to it, and your regular drinking habits could become a problem. Drinking too much alcohol can cause falls and fractures. Alcohol can also cause dangerous interactions when mixed with prescription or over-the-counter medications. Over a long time, it can […]
  • New Medicare cards have started to mail! April 2, 2018
    Medicare has started sending new cards with new Medicare Numbers to people with Medicare. Your new Medicare card will include a new number unique to you, instead of your current Social Security-based number. This will help to protect you against fraud. Starting this month, people who are enrolling in Medicare for the first time will […]
  • At risk for diabetes? Take this quick test. March 27, 2018
    Diabetes affects over 30 million people in the U.S.—are you one of them? Tuesday, March 27 is American Diabetes Association Alert Day, and it’s a great time to take the Diabetes Risk Test to find out if you’re at risk for developing type 2 diabetes, a disease where blood glucose levels are higher than normal. […]

Call us (215) 738-8100 or send us a message!

11 + 7 =