Medicare Part C, or Medicare Advantage, is coverage from a private insurance company. These plans can offer an array of benefits ranging from dental, vision, hearing, and gym memberships. Many Part C plans have a $0 premium, so it’s easy to see what attracts people to these plans. But, even with all the perks, there are downfalls to Medicare Advantage.
What is Medicare Part C
When you choose a Medicare Advantage plan, a private company will handle your benefits and claims instead of the federal government. The policy must cover at least as much as Medicare. Unless you go out of the network.
Part C must cover all services that have coverage under Part A and Part B. Most plans include more than Medicare. Also, many Part C plans cover preventive care and prescription drugs; some offer dental and vision benefits. Some plans even include over the counter medication benefits.
If you’re in a Private-Fee for Service (PFFS) plan without drug coverage, you can add drug coverage by enrolling in a Part D plan. No matter which policy you choose, it’s important to verify the Part D formulary.
Over 90% of Advantage plans include transportation assistance, and over 95% cover a meal benefit. Also, some plans include telehealth services or in-home support. Further, some Medicare Advantage plans offer Part B give-back option that lowers or eliminates your Part B premium costs.
Some Medicare Advantage plans now cover Long Term Care benefits. These benefits aren’t mandatory, so not all plans offer them. But, there may be plans in your area that include these benefits.
You must have Both Part A and Part B to be eligible for Part C. The one health question that can disqualify you for a Medicare Advantage plan is, “do you have End-Stage Renal Disease?” Unless you develop End-Stage Renal Disease when you’re already on a Medicare Advantage plan, you won’t be able to select this coverage.
If you already have Medicare Advantage when you develop ESRD, you might be able to select a different plan with the same company. Also, if the plan leaves the area, you’ll have a one-time right to choose another policy.
Further, if an ESRD Special Needs Plan is available in your area, you may join. Also, if you have a successful kidney transplant and no longer have ESRD, you’ll qualify for Medicare Advantage coverage.
CMSnewsroom claims ESRD patients will have access to Medicare Advantage plans by 2021 or 2022.
Medicare Part C vs Original Medicare
Under Part A and B, there are no provider networks; so, you can go to any doctor or hospital you want, so long as they accept Medicare.
Private insurance companies offer Part C through HMOs and PPOs. For each, there’s a list of “in-network” healthcare providers.
If you go to a provider out of the network, your claim may not have coverage, or you’ll pay more for services.
Many Advantage plans have a $0 premium. But, some areas have a higher premium costing plan. The average Medicare Advantage plan cost is about $23 a month. Of course, your location is the determining factor in the plans available to you.
When you live somewhere that has little to now quality plan options, consider the benefits of Medigap.
What happens if you find yourself disenrolled from your Medicare Advantage plan?
Single Grace Period – If one or more payments have gone unpaid during your grace period, the plan can discontinue coverage.
Rollover Grace Period – If you owe more than one premium but manage to pay for a minimum of one premium during your grace period, the period will end, and your plan will notify you of a new grace period.
Notifications continue until you catch up on premiums. But, if you fail to make a premium payment during this time, you face dis-enrollment.
How is Advantage Part C funded?
Upon agreeing to pay your claims, the Medicare Advantage plan receives funding from the government. So, instead of Medicare worrying about paying your claim, it’s the responsibility of the Part C insurer. Some plans also request you to make premium payments. Depending on where you live, the cost of an Advantage plan could be higher than in other areas.
Is Medicare Part C the same as a Medicare Supplement plan?
No, Medicare Supplement plans work with Medicare to provide you the most comprehensive policy.
Why do I need Medicare Part C?
You don’t need Medicare Part C, it’s not mandatory. But, some people choose Part C instead of only Medicare or instead of a Medigap policy.
How to Enroll in Medicare Part C
At MedicareFAQ, we help you navigate the world of Medicare. We’ll explain the pros and cons of your options and research all the top providers in your area. We can look at your Medicare Advantage checklist to find the policy that is most suitable for you.
An agent can ask you a few questions about your needs and wants in a policy. Then, they can help you identify the plan with the most value for you.
Our agents have helped Medicare recipients just like you! If you’re ready to compare rates with the top carriers, give us a call at the number above!
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