Medicare Part C (Medicare Advantage Plans)
Medicare Part C refers to Medicare Advantage plans offered through private companies providing Part A and Part B Medicare coverage. Part C Medicare Advantage plans usually offer extra benefits such as vision, hearing, dental, and/or health and wellness programs and many include prescription drug coverage (Part D). Beneficiaries may have to see doctors in the plan's provider network or go to certain hospitals to get services. If not, they may have to pay the entire cost of the service. Medicare Part C does not cover hospice care (still provided by Original Medicare).
Medicare Part C Usually Covers/Offers
- No or minimal medical deductibles
- Simple copays for most covered services
- An out-of-pocket maximum
- Optional dental benefits
- Coverage for urgent or emergency care when travelling outside the U.S.
- Fitness benefits
- Chiropractic care
- Optional prescription drug coverage with mail-order services
- Vision and hearing benefits
Medicare Part C Enrollment
In order to join a Medicare Advantage plan, beneficiaries must:
- Be entitled to Part A and enrolled in Part B (note: beneficiaries must continue to pay their Part B premium)
- Must maintain a permanent residence for six months or more in the service area of the Medicare Advantage plan
Beneficiaries may choose not to enroll in a Medicare Advantage drug plan, however penalties may apply for late enrollment (view details.) And enrollees may have to pay an extra monthly premium in addition to the monthly Part B premium (note: enrollees will still be responsible for the Part B premium).
Types of Medicare Advantage Plans
An HMO (Health Maintenance Organization) plan requires beneficiaries to generally only see doctors, specialists, or hospitals that are part of the plan's network, except in an emergency. Providers must accept Medicare to ensure care is covered.
A PPO (Preferred Provider Organization) plan has a network of providers, but beneficiaries can also use out-of-network providers for covered services, usually for a higher cost share. Providers must accept Medicare to ensure care is covered.
A SNP (Special Needs Plan) is a type of Medicare Advantage plan in which membership is limited to certain Medicare beneficiaries, such as those in certain institutions (like a nursing home), those eligible for both Medicare and Medicaid, or those with certain chronic or disabling conditions.
An MSA (Medical Savings Account) plan combines a high deductible health plan with a Medical Savings Account that beneficiaries can use to manage their health care costs. Once the deductible is met, the plan covers 100 percent of Part A and Part B costs.
- There are no premiums for MSAs.
- Beneficiaries must still pay a Part B premium.
- Prescription drugs are not covered in an MSA Plan, although enrollment in a prescription drug plan is permitted.
A PFFS (Private Fee-For-Service) plan is a type of Medicare Advantage plan in which a beneficiary is not limited to a specific network of providers. An enrollee may receive covered services from any provider in the U.S. provided they accept Medicare and agree to the PFFS plans' terms and conditions for payment. Providers are not required to accept PFFS plan enrollees, and may or may not decide to treat the beneficiary. It is the responsibility of the enrollee to notify a Provider prior to the visit of their PFFS coverage.