PART C
Part C is known as Medicare Advantage. Insurance companies contract with the Centers of Medicare and Medicaid (CMS) to provide these private plans. All Medicare Advantage plans, by law, must provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage and must cover medically necessary services. But here's the tricky part, there's lots of variation among Medicare Advantage plans. One plan one may cover less of one thing and another plan may cover more, but they must at least be "equivalent" to regular Part A and Part B. This can be very confusing when trying to choose between plans offered by different insurance companies.
To complicate things even further, Medicare Advantage Plans generally offer additional benefits.These plans often have networks, which mean you may have to see certain doctors and go to certain hospitals in the plan's network to get care. Some Part C plans provide coverage that goes way beyond what you get in Parts A and B - including, in some cases, prescription drug coverage - but not all. The better plans basically function like Medigap policies but are administered by Medicare rather than being wholly run by private insurance companies.
If you have a Medicare Advantage plan, any Medigap policy you may have is useless. Medigap won't pay if you are covered by a Medicare Advantage plan.
Medicare Advantage Plans may save you money, because out-of-pocket costs in these plans are generally lower than with Original Medicare alone. However, your cost will vary by the services you use and the type of plan you purchase. Each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or can use only doctors, facilities, or suppliers in the network).
Plan options can include:
The monthly premium varies widely depending on your state and the private insurer you choose, as well as whether you choose an HMO or PPO for your Medicare Advantage coverage.
You can generally join if:
Choose your plan carefully, as usually you will only be able to change plans once a year during the Annual Election Period. The Annual Election Period—also called the Open Enrollment Period—is October 15 through December 7. In 2012, the Disenrollment Period runs from January 1 through February 14. During this time, individuals with a Medicare Advantage plan can disenroll from their plan and switch to Original Medicare. They also have until February 14 to join a Part D plan to add prescription drug coverage.
To complicate things even further, Medicare Advantage Plans generally offer additional benefits.These plans often have networks, which mean you may have to see certain doctors and go to certain hospitals in the plan's network to get care. Some Part C plans provide coverage that goes way beyond what you get in Parts A and B - including, in some cases, prescription drug coverage - but not all. The better plans basically function like Medigap policies but are administered by Medicare rather than being wholly run by private insurance companies.
If you have a Medicare Advantage plan, any Medigap policy you may have is useless. Medigap won't pay if you are covered by a Medicare Advantage plan.
Medicare Advantage Plans may save you money, because out-of-pocket costs in these plans are generally lower than with Original Medicare alone. However, your cost will vary by the services you use and the type of plan you purchase. Each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or can use only doctors, facilities, or suppliers in the network).
Plan options can include:
- Health Maintenance Organization Plans (HMO)
- Point of Service Plans (HMO-POS)
- Preferred Provider Organization Plans (PPO)
- Private Fee-For-Service Plans (PFFS)
- Special Needs Plans (SNP)
- Medical Savings Account (MSA)
The monthly premium varies widely depending on your state and the private insurer you choose, as well as whether you choose an HMO or PPO for your Medicare Advantage coverage.
You can generally join if:
- You live in the service area of the plan you want to join.
- You have Medicare Part A and Part B coverage.
- You don't have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Choose your plan carefully, as usually you will only be able to change plans once a year during the Annual Election Period. The Annual Election Period—also called the Open Enrollment Period—is October 15 through December 7. In 2012, the Disenrollment Period runs from January 1 through February 14. During this time, individuals with a Medicare Advantage plan can disenroll from their plan and switch to Original Medicare. They also have until February 14 to join a Part D plan to add prescription drug coverage.