What is Medicare Part C?

By | March 7, 2010

To understand what is Medicare Part C, you need to know that it is the same as a Medicare Advantage Plan.

Medicare Advantage Plan (MA Plan), or Medicare Part C, is an alternative choice to the original Medicare plan. Medicare Advantage plans may be an HMO or a PPO. They are offered by private insurance companies. These insurance companies are approved by Medicare. Part C must provide coverage to all of the services provided by Medicare Hospital Insurance (Part A) and Medicare Medical Insurance (Part B) except Hospice care. Hospice care is covered by Medicare, even if you have a Medicare Advantage Plan.

Both the original Medicare plan and Part C cover you for emergency and urgent care. In addition Part C plans may offer extra coverage such as vision, hearing, dental, and/or health and wellness programs. Many plans include Medicare Part D – prescription coverage.

Medicare Part C plans require you to pay a monthly premium in addition to the part B monthly premium. Similar to Medigap coverage, Part MA plans may provide more coverage than the original Medicare. However, Medicare Advantage Plans are not considered supplemental coverage. They eliminate the need for a Medicare Supplement Insurance policy. As a matter of fact you cannot be sold Medigap coverage while you are in a Medicare Advantage Plan. Medigap will not cover your MA Plan deductibles, copayment, or coinsurance.

Under Part C you have the same Medicare rights and protection as you do under parts A and B. This includes the right to appeal. You can join an MA plan even if you have a pre-existing condition, except for ESRD. You can join a plan only during certain times of the year. Coverage periods are usually for the calendar year. If the plan decides to stop participating in Medicare, you will either have to join another Medicare health plan, or use the Original Medicare plan.

Prescription drug coverage (Part D) is usually supplied through the plan. If you are in a plan that includes prescription drug coverage, you should not try to join a Medicare Prescription Drug Plan. If you do, you will be removed from your Medicare Advantage Plan and returned to basic Medicare.

There are many different types of MA plans. These plans include: Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee for Service (PFFS), Medical Savings Account (MSA) and Special Needs Plans (SNP). Less common plan types include: Point of Service (POS) and Providers Sponsored Organizations (PSO).

Each MA plan is different. They do not operate in the same way. Each plan charges its own set of out-of-pocket cost. The rules for how you get services also differ by plan. You may need a referral to see a specialist in one plan and not the other. Similarly, a plan may restrict you to go to only the doctors, facilities, or suppliers that belong to the plan. If you go to a doctor, facility, or supplier not in the plan, your services may not be covered or cost you more.

There are many choices of Medicare Part C plans. These are offered by private companies that are paid a set monthly fee from Medicare. Resources found online and including this site can lead you to more information about Medicare Advantage Plans.