Medicare Part C Plans: The Basics Of Cost, Coverage, And Enrollment

This month we continue our four part series on the four main parts of Medicare. Each section will focus on one alphabet part to help clear up the coverage, eligibility, cost, and enrollment for that particular area.

So far we’ve covered Medicare Part A and Medicare Part B. This week, we’ll continue with taking a closer look at Medicare Part C.

What is Part C?

Medicare Part C, also known as a Medicare Advantage plan, is different from Part A and B mainly because it is offered by private health insurance companies, not the government. Medicare Advantage plans combine coverage for Medicare Parts A and B and includes additional medical services such as prescription drug coverage for those who want it.

What Does Part C Cover?

Medicare Part C will provide all the basic coverage included in Part A and Part B such as hospital stays, skilled nursing services and home health as well as doctor’s visits, outpatient care, screenings, shots and lab tests.

However, because it is a plan provided by private insurance companies, there are a number of other options available. Many plans may also provide expanded coverage for everything such as prescription drug coverage, eye care, hearing problems, preventative care, wellness programs, and a 24-hour nurse helpline.

What Does Part C Not Cover?

Medicare Part C, or Medicare Advantage, must cover the same services as Original Medicare Part A and Part B, except it does not provide hospice care. You can still keep you Medicare Advantage Plan and receive hospice at the same time. Your Medicare Part C covers your health benefits not related to your hospice care.

You will have to look at your specific plan details to see what other exclusions there may be. For help deciphering your Medicare Part C plan, talk to an independent agent today.

What Providers Can I See?

The terms of Medicare Part C plans vary. In some plans, your health care is “coordinated.” This means the plan coordinates you coverage through a primary care doctor who manages the care you receive from specialists and hospitals. You may have to choose specific doctors and hospitals in this situation.

In other plans, you can get care from any Medicare-eligible provider who accepts the terms, conditions, and payment rates of the plan before providing coverage. Doctors and hospitals can decide whether or not to accept those terms, conditions, and payment rates each time they furnish covered services.

All Medicare Advantage plans have “service areas.” These are areas, typically a county, state, or region, where they offer coverage. Generally, you must live in a plan’s service area in order to join it. However, all Medicare Part C plan must offer nationwide coverage for emergency care, urgent care, and renal dialysis.

Who is Eligible for Part C?

As soon as you become eligible for Medicare, you can join Part C. Typically eligibility is determined by age for those 65 or older, or individuals who have other qualifying conditions.

How Much Does Medicare Advantage Cost?

The cost of Medicare Part C varies from one plan to another because it is offered through a variety of private companies. You will need to continue paying your Medicare Part B premium as well as your Part A premium, if you have one. The added cost of your expanded benefits will depend upon the coverage and insurance provider you select.

Insurers can change premiums and other terms of the plan from year to year. Each autumn, insurers announce next year’s premiums and other terms of their plans.

How Do I Enroll in Medicare Advantage?

Before you enroll in a Medicare Part C plan you will have to enroll in Medicare Parts A and B. Generally, individuals are automatically enrolled in both if they are already receiving Social Security. Otherwise, you will need to contact your local Social Security office to enroll.

Once you are enrolled in Parts A and B you can select a Medicare Advantage Plan. For most people, this can all be done at the same time, when they turn 65 years of age. There is a seven month window to enroll which starts three months before your birthday month and ends three months after.

If you miss that window or choose not to enroll initially there is an Annual Enrollment Period (AEP) each year during which you can decide to enroll in a Medicare Advantage Plan. This period lasts about six weeks and runs from October 15th through December 7th.

Can I Be Refused a Medicare Advantage Plan?

Assuming you have joined Medicare Parts A and B, you can not be refused by any plans in your area that are accepting new members. Some Medicare Part C plans have special eligibility rules that you must satisfy in order to join the plan. The time when your coverage begins depends on when you sign up.

How Do I Renew My Medicare Advantage Plan?

Your plan renews automatically from year to year, so long as you pay your premium and the plan is still available in your service area. Other than those two conditions, you do not have to do anything else.

We Are Your Medicare Advantage Experts

With so many plan options and so many private insurance companies to choose from, finding the perfect plan can be a chore. Don’t take on this burden yourself.

The independent agents at Braden Insurance Agency are experts in all things Medicare. We will shop around at the many private insurance companies and find the plan that fits best with your health needs and budget. Call us today for a free consultation!

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