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Medicare Advantage (Part C)

Senior man sitting at table reading the label on a prescription.

When you become eligible for Medicare, you may consider Medicare Part C or a “Medicare Advantage Plan.” Medicare Advantage Plans are referred to as Medicare Part C and are offered by a set of approved private insurance companies. A Medicare Advantage plan works differently than a Supplement. With a Medicare Advantage Plan, a private company takes over the primary coverage responsibilities from Medicare (you remain in the system but Medicare no longer is responsible for your bills). These plans are similar to HMO or PPO group plans. Medicare Part C or Medicare Advantage Plans offer all the benefits of Part A (Medicare hospital insurance) and Part B (medical insurance), with added benefits for hearing, vision, dental coverage. In addition, most Medicare Advantage plans include prescription coverage (Medicare Part D).

Medicare Part C and You

You may consider Medicare Part C, as this type of coverage offers more than Original Medicare. Original Medicare covers Medicare Part A and Medicare Part B, but without prescription drug coverage. Since these plans are offered to the public by private insurance companies, the cost of coverage varies. You will be responsible for paying your premiums, deductibles, and copays, which vary from plan to plan. One benefit of Medicare Part C is that the out-of-pocket costs are capped, and once you reach the cap, you will owe nothing more for that year.

Consider Your Options

If you have a medical professional you want to continue to see, check the yearly provider list for the Medicare Part C plan before you enroll, or ask your doctor at your next appointment. The various insurance companies vary in the cost of premiums and the range of benefits, so reviewing the alternatives is a crucial step in choosing the right Medicare Advantage Plan.

How to Enroll in Medicare Part C

You have the option to enroll in Medicare Part C during the initial enrollment period, which is seven months spanning the three months before you turn 65 to the three months following your 65th birthday. You have the option to upgrade to a Medicare Part C plan to replace Original Medicare during the Medicare Enrollment period, which runs from October 15th to December 7th. You can change your existing Medicare Part C at the Medicare Advantage enrollment period from January 1st to March 31st.

With the Medicare Advantage plan, it is important to remember:

  • Most Advantage Plans have networks. You must make sure that your doctor, hospital, and auxiliary-care facilities are within the network. (If not, you will be paying higher costs for going outside the network for health care).
  • Advantage Plans have co-pays associated with each visit or service. It is important to be aware of these charges because they can add up to a significant sum. This is a nice bonus, but you must be aware that switching to a Supplement from an Advantage Plan typically means you will also need to add a Part D. (Some exceptions apply).
  • Advantage Plans typically have value-added benefits. These benefits vary between plans but typical benefits include a Health Club membership or limited dental and vision coverage.

Not all Plan D’s are the same. They can vary greatly in costs, co-pays, and specific drugs that are covered. It is important to check which one suits you and continue to check each year because their coverage parameters change every year.

*Disclaimer: This page has not been reviewed or endorsed by or any member of the Centers for Medicare & Medicaid Services (CMS).

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