Medicare Part C

Medicare Part C is also called Medicare Advantage (MA). It’s an alternative benefit form to Original Medicare. Medicare Advantage may include prescription drug coverage, along with extra benefits, and is offered through private insurance companies.

When should you sign up?

If you choose to enroll in Medicare Advantage, you can enroll when you first become eligible for Medicare, or during the annual enrollment period (October 15th – December 7th). There are special enrollment periods for people who lose credible coverage.

Is there a premium?

There is usually a premium, but in some cases there is no premium. Our company offers Medicare Advantage plans as part of our product portfolio.

In general, Medicare Advantage:

  • Offers the same or greater benefits than Original Medicare
  • May include extras like wellness, vision, hearing and dental care, plus fitness club membership
  • May include prescription drug coverage
  • Requires payment of copays and/or coinsurance for covered services
  • Protects you with an annual out-of-pocket maximum (generally $6,700 to $10,000  yearly)
  • Requires you to see doctors in their network to receive the lowest cost

There are several Medicare Advantage plan options:

  • Health Maintenance Organizations (HMOs) use a network of doctors and hospitals to lower your costs. You cannot use providers outside of the network except in case of emergency.
  • Preferred-Provider Organizations (PPOs) allow you to use doctors outside the network but you generally pay more for services.
  • Private Fee-for-Service Plans (PFFS) require no special networks or providers. You can visit any doctor or hospital that is eligible to receive payment from Medicare, agrees to treat you and accepts the plan’s terms and conditions. PFFS plans are being phased out in most areas.
  • Special Needs Plans (SNPs) are designed to meet the specific needs of Medicare beneficiaries who meet one of the following criteria:
    • Are eligible for state Medicaid health insurance
    • Have needed or are expected to need the services provided by a long term care or skilled nursing facility for 90 days or longer
    • Have a specific severe or disabling chronic condition
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