What You Need To Know About Medicare Part C
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What Is Medicare Part C?Medicare Part C, also called Medicare Advantage, is an alternative to Original Medicare. Medicare Part C bundles Parts A and B. With Part C, you’ll receive the same Medicare Part A and Part B coverage, with added benefits such as hearing, vision, and dental. Most Medicare Part C plans also include prescription drug coverage (Medicare Part D).
Did You Know: Medicare Advantage (Medicare Part C) and Medicare Supplement (Medigap) plans may sound alike, but they are quite different. Our Medicare Part C vs. Medigap comparison breaks down the pros and cons of each plan.
Different Types of Medicare Part C PlansMedicare Part C isn’t just one plan; there are several options. Keep in mind that not all plan types may be available in your area. These are five of the most common Medicare Advantage Plans:3
- Health Maintenance Organization (HMO) plans. HMO plans come with a group of in-network doctors, medical facilities, and other health care providers. HMO plans often require a referral to see a specialist.
- Preferred Provider Organization (PPO) plans. PPO plans allow you to see both in-network (preferred providers) and out-of-network providers. Seeing an out-of-network provider usually comes at a higher out-of-pocket cost.
- Private Fee-for-Service (PFFS) plans. With a PFFS plan, you can visit any provider, as long as they are eligible to receive payment from Medicare and agree to the plan’s terms and conditions of payment.
- Special Needs Plans (SNPs). SNPs provide benefits and services to people with specific diseases, certain health care needs, or limited incomes.
- Medical Savings Account (MSA) plans. These plans combine a high-deductible insurance plan with a medical savings account, which you can use to pay for health care costs.
How Do I Enroll in Medicare Part C?As we mentioned earlier, Medicare Part C plans are offered through private insurance companies that contract with Medicare. You won’t be automatically enrolled in a Medicare Advantage plan when you become eligible for Original Medicare. If you’re interested in a Medicare Part C plan, give yourself plenty of time to research and compare Medicare Part C providers and pricing before the enrollment period. The number of Medicare Advantage plans available will depend on where you live. Use Medicare’s Plan Finder to see the available plans in your area and view star ratings for the overall plan quality and performance.
Medicare Advantage Enrollment Dates
|Enrollment period||Date||Important details|
|Initial enrollment period||When you first become eligible for Medicare||Your initial Medicare enrollment period lasts for seven months, starting three months before you turn 65 and ending three months after the month you turn 65.|
|Medicare annual enrollment period||Oct. 15 – Dec. 7 of each year||You can join, switch, or drop a plan. This includes Medicare Advantage and Medicare Part D plans.|
|Medicare Advantage open enrollment period||Jan. 1 – March 31 of each year||If you’re enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or to Original Medicare (and join a separate Medicare drug plan). You can only switch once during each open enrollment period.|
|Special enrollment periods (SEPs)||During certain special circumstances and changes in your life4||Examples include moving to a skilled nursing facility or long-term care hospital. Rules about when you can make changes (and the type of changes) are different for each SEP.|
From the pros: Avoid costly late fees and penalties by following our valuable Medicare enrollment guide!
What Does Medicare Advantage Cover?Think of Medicare Part C as an all-in-one Original Medicare package. What’s covered under Medicare Part A and Part B is also covered under a Medicare Part C plan. The big difference? While Original Medicare does not cover prescription drugs, dental, vision, or hearing, many Medicare Part C plans offer these (or some of these) additional benefits. Medicare Part A, also known as hospital insurance, helps pay for inpatient hospital care. This includes medication as part of your inpatient treatment, a semiprivate room, meals during your hospital stay, and short-term care at a skilled nursing facility (following a hospital stay).
Quick tip: Wondering why Original Medicare is split into two parts? Head over to our Original Medicare breakdown to find out why we have Medicare Part A and Part B.
What Is the Cost of Medicare Part C?Your Medicare Advantage costs depend on several factors. A key factor is the insurance provider you choose. This is because private insurance companies set their own plan pricing, so your monthly premium, out-of-pocket expenses, and deductible are directly linked to that specific provider. For example, UnitedHealthcare’s Medicare Advantage plan pricing may differ from other carriers, such as Aetna or Blue Cross Blue Shield. Be sure to review the plan specs of several Part C providers — you may be surprised to find the same benefits at a lower cost! When you’re comparing Original Medicare and Medicare Advantage pricing, a standout piece of the Medicare puzzle is out-of-pocket expenses. With Original Medicare, there is no out-of-pocket limit. This can result in a major hit to your wallet. However, with Medicare Part C plans, each provider sets an out-of-pocket plan limit. The average out-of-pocket cost for Medicare Advantage enrollees is $5,091 for in-network services (HMOs and PPOs) and $9,208 for both in-network and out-of-network services (PPOs).
Medicare Advantage Out-of-Pocket MaximumFederal regulations require all Medicare Advantage providers to set an out-of-pocket limit that cannot exceed:5
|Medicare Parts A & B in-network services||$7,550 maximum|
|Medicare Parts A & B in-network and out-of-network services combined||$11,300 maximum|
|Medicare Part D||$6,550 maximum|
- Annual Notice of Change: By Sept. 30, you’ll receive a printed Annual Notice of Change from your Medicare Part C provider. The document will include all changes to your Part C plan effective Jan. 1, such as updated coverage, costs, and service areas.
- Evidence of Coverage: By Oct. 15, you’ll receive a plan notice with instructions on how to electronically access your Evidence of Coverage (or request a printed copy). The Evidence of Coverage details how much your plan costs and what the plan covers.
FYI: Medicare Advantage plan providers can only make changes once a year, in January, to what you pay for the plan.
10 Important Facts About Medicare Part C
- Medicare Part C plans must cover everything that Original Medicare (Part A and Part B) covers. Many Medicare Advantage plans also include Medicare Part D prescription drug coverage.
- If you’re enrolled in a Medicare Part C plan, you’re still in the Medicare program and covered by Medicare’s rights and protections.
- Your Medicare Advantage plan may have a specific network of health care providers and facilities. Avoid costly out-of-network charges by staying in-network.
- Medicare Advantage plans can’t charge more than Original Medicare for certain services, like chemotherapy, dialysis, and skilled nursing facility care.
- Unlike Original Medicare, Medicare Part C plans have an annual out-of-pocket limit. Once you reach the limit, you’ll pay nothing for covered services.
- Some Medicare Advantage plans offer extra benefits that Original Medicare doesn’t cover, such as vision, hearing, dental, or fitness programs.
- Medicare Part C plan providers can join or leave the in-network plan at any time.
- Your Medicare Advantage plan may require a referral to see a specialist.
- Before you receive a hospital or medical service, your Medicare Part C insurance company must provide details on whether the service is covered and what your costs may be.
- If you have a Medicare Advantage plan, it’s illegal for anyone to sell you a Medigap plan unless you’re switching back to Original Medicare.