Medicare Part C

Medicare Part C, or Medicare Advantage, is a health plan offered by private insurance companies approved by Medicare. It covers everything in Medicare Part A (hospital insurance) and Part B (medical insurance).

These plans follow Medicare rules and usually have a network of doctors and hospitals you must use. Many also include prescription drug coverage (Part D).

A big advantage of Medicare Advantage plans is that they often cover extra services that Original Medicare doesn’t, like vision, dental, and hearing care. This makes them a more complete option for health coverage.

Medicare Part C

What does Medicare Advantage cover?

Medicare Part C (Medicare Advantage) includes the same benefits as Parts A and B, but many plans also offer extras like dental, vision, hearing, and prescription drug coverage. Benefits vary by plan.

If a plan doesn’t include prescription drug coverage, you’ll need a separate Part D plan. Always check a plan’s drug list to ensure your medications are covered.

Most Medicare Advantage plans offer transportation, meal benefits, and telehealth. Some also reduce the Part B premium. A few even include long-term care, but this is rare.

With low or no monthly premiums, these plans are appealing, but they have limitations. It’s important to compare them with Medicare supplement plans before deciding.

How Much Does Medicare Advantage Cost?

The cost of Medicare Advantage (Part C) through MAC Insurance depends on the plan and location.

Here’s what to expect:

● Premiums – Many plans have low or $0 monthly premiums, but you’ll still need to pay the Part B premium.

● Deductibles & Copays – Some plans include deductibles, and you may have copays for doctor visits, hospital stays, and prescriptions.

● Out-of-Pocket Maximum – Medicare Advantage plans set a yearly limit on how much you’ll pay out of pocket.

● Extra Costs – Plans that offer dental, vision, hearing, or other benefits may have additional fees.

Since costs and coverage vary, MAC Insurance is here to help you compare plans and find the best fit for your needs.

Types of Medicare Advantage Plans

Medicare Part C plans cater to a diverse range of enrollees, providing various plan types with unique features, network rules, and costs.

Health Maintenance Organization (HMO)

HMO plan is a type of Medicare Advantage that requires you to use a specific group of doctors and hospitals. You usually need to pick a main doctor and get a referral to see specialists. These plans often have lower costs, but you have fewer options for healthcare providers. Many HMO plans also cover prescription drugs.

Preferred Provider Organization (PPO)

PPO plan gives you more freedom to choose doctors and hospitals. You can see any provider, but you’ll pay less if you use those in the plan’s network. You don’t need a referral to see a specialist.

Private Fee-for-Service Plans (PFFS)

PFFS plans let you see any doctor or hospital that accepts Medicare and agrees to the plan’s rules. You don’t have to use a network, but the cost may change depending on the provider. Some PFFS plans also include prescription drug coverage.

Special Needs Plan (SNP)

SNP is a Medicare Advantage plan for people with specific health needs, like certain diseases, those in nursing homes, or people who have both Medicare and Medicaid. These plans are designed to provide extra care based on your health needs.

Medical Medicare Savings Account (MSA)

MSA plan combines a high-deductible health plan with a savings account. The savings account helps pay for medical costs, but you need to pay a larger amount upfront before the plan starts covering your expenses.

Eligibility for Medicare Advantage

To be eligible for Medicare Advantage (Part C), you must meet these requirements:

● Have Medicare Part A and Part B – You must be enrolled in both Medicare hospital insurance (Part A) and medical insurance (Part B).

● Live in the Plan’s Service Area – You must live in the area where the Medicare Advantage plan is offered.

● Not Have End-Stage Renal Disease (ESRD) – Most people with ESRD are not eligible for Medicare Advantage, though there are some exceptions.

If you meet these conditions, you can choose a Medicare Advantage plan that fits your needs.

Comparing Medicare Part C to Original Medicare

With Original Medicare (Parts A and B), there are no provider networks. You can choose any provider that accepts Medicare.

With a Medicare Advantage plan, you need to choose a provider within the plan’s network. Two types of Part C plans are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).

● HMO plans only cover services within the network, except for emergencies.

● PPO plans offer some coverage outside the network, but it costs more and you’ll pay more out-of-pocket.

Medicare Advantage Disenrollment

Plans with a Single Grace Period may cancel coverage if a member misses one or more premium payments.

Plans with a Rollover Grace Period allow members to stay enrolled if they miss a payment but pay at least one during the grace period. A new grace period will start after that.

Insurance companies will notify members who haven’t paid their premiums but will cancel coverage if payment isn’t made during the grace period.

If a member is disenrolled, they’ll need to submit a new application for coverage.

How to Sign Up for

MEDICARE ADVANTAGE

Once you’ve applied for Medicare Parts A and B, it’s important to work with a licensed agent to determine if a Medicare Advantage plan is the right choice for you. We’ll go over the benefits and drawbacks of these plans to ensure you fully understand your options.

If you decide to enroll in a Part C plan, we’ll compare various plans and carriers to find the best coverage at the most competitive rate. We’ll handle the application for you and remain available to answer any questions once your coverage starts.

ADDITIONAL QUESTIONS TO BE ADVISED ON:

How is Medicare Part C financed?

Some Part C plans have a $0 premium, but you might wonder how they’re paid for. Private insurance companies that offer these plans get funding from the government to cover the services. Instead of Medicare paying for claims, the insurance company takes care of them. Some plans may still have additional costs, like premiums, copays, or coinsurance.

Is Medicare Advantage the same as Medicare Supplement plans?

No, Medicare Supplements work alongside Original Medicare to help cover extra costs. Medicare Advantage plans replace Original Medicare and offer all-in-one coverage.

Why should I consider a Medicare Advantage plan?

Medicare Part C is optional, but signing up for a Medicare Advantage plan or a Medigap policy can help cover costs that Original Medicare doesn’t pay for.

Are there any limitations on coverage with Medicare Advantage?

Yes, there are some limits with Medicare Advantage. You may need to use certain doctors and hospitals in the plan’s network, and some services like dental or vision care might not be covered.

We are not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area, and any information we provide is limited to those plans we do offer in your area. Please get in touch with Medicare.gov or 1-800-MEDICARE to get information on all your options.

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