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Medicare Part C

Medicare Part C (Medicare Advantage Plans)

Medicare Advantage plans are an alternative way to receive Medicare coverage. There are managed care plans administrated by private insurance companies that Medicare has approved. These plans bundle in the benefits of Medicare Part A, and B, and even Part D.

Medicare Advantage plans aka Medicare part C cover the exact same thing as Original Medicare, Part A, and Part B, covers. They may provide extra coverage, such as hearing, dental, vision, wellness, and health programs. If you’re a beneficiary of Part A and Part B, you can enroll for Medicare Advantage plans.

However, you have to remain enrolled in Original Medicare, and you will have to pay your Medicare part B premium. So, you will have to keep paying for Part B even if you enroll in Medicare Part C.

What does Medicare Part C Cover?

Medical Advantage plans cover the following services

  • Inpatient care
  • Outpatient care
  • Home health service

Types of Medicare Advantage Plans

Here are different types of Medicare Part C

Health Maintenance Organization Plan (HMO)

In HMO plans, you could use only in-network doctors and hospitals. There is no Medicare coverage out of network unless you need an emergency. This plan requires you to build a primary care physician to get referrals from it when you see a specialist. HMO plan could be a great option for you if your doctor is already in the network because you’re going to pay less from your pocket.

Preferred Provider Organization Plan (PPO)

Using a PPO plan, you will get coverage both in and out of the network. On a PPO plan, you can choose any hospital and doctors that accept Medicare. Unlike HMO, this plan does not require you to establish a primary care physician. So, there is no need for any referrals to see a specialist.


Private Fee for Service Plan (PFFS)

PFFS plan may be a great option for you if;

  • It’s available in your area
  • If your physician and Hospital accept the PFFS plan’s terms and condition

If your doctor and Hospital don’t accept the plan’s payment terms, your PFFS plan will not provide coverage through that physician and doctor.

Special Needs Plan (SNP)

SNP is for those who qualified for special health care needs. You can be eligible for SNP if you meet the following requirements;

  • You’re eligible for Medicare and Medicaid
  • If you have a condition that is considered severe or disabling
  • You’re institutionalized, such as in a long-term skilled nursing facility

HMO- Point of Service (HMO-POS)

This plan offers both in-network and out-network Medicare coverage at different rates. Moreover, you will pay less when you visit in-network physicians, labs, and hospitals.

Who is eligible for Medicare Part C?

If you’re a beneficiary of Part A and Part B, you’re also eligible for Medical Advantage plans.


When to enroll for Medicare Part C?

There are specific enrollment periods

Initial coverage election Period

This is a seven-month period that starts three months before you reach 65.

Annual election period

The AEP period runs from October 25 to December 7.

Open Enrollment Period (OEP)  

OEP period runs from January 1 to March 31.