What Is A Medicare Advantage (Part C) Plan

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What Is a Medicare Advantage (Part C) Plan

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Medicare Advantage plans offer Medicare coverage via private health insurance companies authorized to be in the Medicare program.

The plans can be Regional PPOs, HMOs, or Private Fee-for-Service plans. Medicare Part C covers all services included in Medicare Parts A and B.

If you are eligible for Original Medicare, then you are eligible for Medicare Advantage programs in your area.

Medicare Part A (hospital coverage) covers home health care, inpatient hospital stays, and skilled nursing facility care.

Medicare Part B (medical coverage) covers preventive screenings, lab tests, x-rays, outpatient services, and doctor’s visits.

Medicare Advantage provides other benefits such as:

• Long-term care services. Original Medicare does not entail long-term care like specialized home care and meal delivery, which is available with Medicare Part C.

• Savings. Medicare Part C plans provide out-of-pocket restrictions on costs related to your care, which original Medicare lacked.

• One stop shop. Vision care, prescription drugs, dental care, flex cards and other significant benefits may also be listed in your Medicare Part C plan.

Enrolment in a Medicare Advantage Plan

Even if you are satisfied with your existing health care coverage, it is good to review your plan when it’s time for open enrolment to establish if you are overpaying or if your benefits will change in the following year.

You can visit your Social Security office, call a Medicare Advantage provider for joining information, or join online. These are the times to enroll:

• Initial Enrolment Period. Most people usually have a 7-month open enrolment period around their 65th birthday to enroll in Medicare. You can register three months before your 65th birthday, on the month of your 65th birthday, and three months after your 65th birthday.

• Fall Open Enrolment. The Medicare fall open enrolment happens from October 15 to December 7. All plans chosen within that time frame come into effect on January 1.

• Medicare Advantage Open Enrolment. You are allowed to switch Medicare Advantage Plans from January 1 to March 31. You can either revert to original Medicare, enroll for Medicare Part D or opt out of Medicare Part D.

• Special Enrolment Period. This is a period brought about by different situations that differ individually.

Types of Medicare Advantage Plans

Medicare Part C plans are of two types; Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO).

Health Maintenance Organization Plans

This is a popular option for people who require additional coverage not included in the original Medicare. With a Medicare Advantage HMO plan, it’s possible to receive care from the plan’s in-network health experts. However, you will require a referral to consult a specialist.

Each state has different HMO plans, including some with low copayments, no deductibles, and $0 premiums. You are eligible for the Medicare Part C HMO plan if you already have original Medicare.

Preferred providers Organization Plans

These are the most popular for extra health coverage. This Medicare Advantage PPO plan gives buyers much more freedom.

A PPO plan allows individuals to consult their favorite healthcare facilities, specialist, and doctors, irrespective of whether they are in the plan’s network.

But, PPO plans to charge different rates depending on in-network and out-of-network providers. PPOs are also good as you do not require a referral to consult a specialist.

What is the Cost of Medicare Part C?

There are different costs related to the Medicare Part C plan. Depending on your chosen plan, this means a variation in your out-of-pocket costs.

Some plans cover a part of your Medicare Part B monthly contributions.

But, some of the programs have individual premiums and deductibles. On top of these costs, you can also owe a copayment when seeking medical services.

Medicare Part C has many advantages, including an annual cap on the amount you’ll incur out-of-pocket.

Nonetheless, the initial costs can accumulate before you reach the cap. Therefore, it is essential to consider all your financial and medical factors when selecting a Medicare Part C plan.

Do I Require Medicare Part C?

Medicare Advantage plans are optional. However, if your health situation requires more than basic medical and health insurance, then Medicare Part C would be good coverage.

Suppose you are satisfied with your current coverage and only want prescription drug coverage.

In that case, you can enroll in the stand-alone Medicare Part D. On the other hand, if you already have Medicare coverage but require extra help with costs.

You can get a Medicare supplemental insurance (Medigap) policy.

Unlike Medigap plans, Medicare Part C plans are operated by private insurers and work like conventional health insurance.

This means that you cannot have both Medicare Advantage and Medigap simultaneously. So, you must figure out the type of coverage best suits your needs.

Medigap plans do not substitute your original Medicare plan. Instead, they improve your Medicare coverage with services not included in the original Medicare.

On the other hand, Medicare Part C can replace original Medicare. Medicare Part C and Medigap serve as answers to fill the disadvantages of actual Medicare coverage.

Medicare Part C is an extra and unnecessary cost for some people, which they can’t afford. In such a scenario, shopping for Medicare Part D or Medigap would be better to save money.

Unless you choose an alternative, you will have original Medicare.

Instead of original Medicare, you may opt to receive your Medicare benefits from Medicare Part C, also known as Medicare Advantage Plan or Medicare private health plan.

Remember, you still got Medicare if you buy a Medicare Advantage Plan.

You’ll still contribute your monthly Part B and Part A premiums. Each Medicare Part C offers Part A and Part B benefits from the original Medicare.

However, they can do so with different restrictions, costs, and rules that can impact when and how you receive care.

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