What Is Medicare Part C?

Medicare Advantage plan, also known as Medicare Part C, is a comprehensive plan that provides all of the coverage of the Original Medicare plan plus some extras. Private companies with Medicare approval offer this coverage to anybody who may require more coverage than the original medicare plan offers.

When you enroll in a Medicare Advantage Plan, you'll no longer need to worry about Part A (Hospital Insurance) or Part B (Medical Insurance) of the original medicare plan because the plan will cover those costs. The supplemental coverage of Medicare Advantage Plans may include benefits like hearing, vision, dentistry, wellness, and health programs. Most have Medicare prescription medicine coverage (Part D).

Each month, Medicare will pay a set amount to the insurance company providing your Medicare Advantage Plan. Medicare has requirements that these companies must abide by. However, every Medicare Advantage Plan can determine its own out-of-pocket expenses and criteria for accessing services, such as whether you need a referral to visit a specialist or can only access non-emergency or non-urgent care from providers who are part of the plan. Such regulations are subject to annual review and possible revision.

Types of Medicare Advantage Plans

1. HMO Plans

Those who seek more comprehensive health insurance than what standard Medicare provides often choose Health Maintenance Organization (HMO) plans. You can see doctors who are part of your Medicare Advantage HMO plan's network without a reference, but you'll need one to see a specialist.

Each state offers a variety of Medicare Advantage HMO plans, some of which have no monthly premiums, no annual deductibles, and minimal copayments. If you are not enrolled in original Medicare, you cannot join a Medicare Advantage HMO.

2. PPO Plans

The most widely selected type of healthcare plan for supplemental insurance is Preferred Provider Organizations (PPOs). Those who opt for this plan enjoy more flexibility than those who don't.

If you have a PPO plan, you can see any doctor, specialist, or hospital that accepts your insurance, regardless of whether or not they participate in your PPO's network. PPO plans, on the other hand, have differing fees for in-network and out-of-network providers.

Services That Medicare Advantage Programs Cover

Compared to Original Medicare, Medicare Advantage Plans may offer more comprehensive coverage, including wellness programs and preventative treatment for the eyes, ears, and teeth. Plans may also choose to provide coverage for additional benefits. Some plans may include wellness-related services, transportation to and from medical appointments, and even over-the-counter medications as part of their coverage. Benefit packages can be modified to include these benefits for enrollees with chronic conditions. The advantages included in these packages are tailored to address particular health issues. Before enrolling, you should learn more about the plan's benefits, eligibility requirements, and any other restrictions that may apply. Many Part C plans out there include the following extra benefits:

• Vision

• Medicines on prescription

• Transporting patients to medical appointments

• Dental

• Hearing

• Gym subscriptions

• After an inpatient stay, home food delivery

Do You Qualify for Medicare Part C?

Part C of Medicare is only available to people who have Parts A and B and live within the coverage region of the Medicare Advantage plan provider of their choice.

In 2021, according to legislation passed by Congress, patients with ESRD (end-stage renal disease) can participate in a wider variety of Medicare Part C. Before this law, if you were diagnosed with ESRD, you would have had difficulty getting accepted into a plan or been limited to an SNP (special need plan).

The Price of Medicare Advantage Plans

Several factors influence the total cost of a Medicare Advantage Plan. As a general rule, you can only see doctors who are in the plan's network. Some plans will only pay for care from providers in their network or outside their service area.

Your annual out-of-pocket maximum for both Part A and Part B treatments is limited by Medicare Advantage plans. After this amount is reached, Part A and B services will be provided at no further cost. This is one of the extra advantages of Medicare Part C.

Does Medicare Part C Fit Your Needs?

Medicare Part C is a wonderful choice if you require more comprehensive coverage than what a standard Medicare plan offers.

A standalone Part D Medicare plan may be the best choice if you're already satisfied with your standard Medicare coverage and only looking for prescription medication coverage.

A Medicare supplement insurance policy (Medigap) may be appropriate if you already have Medicare coverage but require additional financial support.

Some Medicare recipients cannot afford the added expense of Part C, but they may be able to save money by comparing prices on Medigap and medicare part D plans.

If you're looking for assistance with choosing the right Medicare Advantage plan that meets your needs, look no further than clearmatchmedicare.com. As a licensed Medicare agent, they can provide professional advice and guidance to help you make an informed decision.

How Medigap Plan Interact With Medicare Advantage Plan

Medigap policies are unavailable to those already enrolled in a Medicare Advantage policy. Your Medicare Advantage Plan-related expenses cannot be covered by Medigap.