Quick Guide to Medicare Part C

Medicare Advantage Plans (like HMOs and PPOs) are sometimes referred to as Medicare Part C. They are private Medicare approved health plans for those individuals eligible for Medicare. When you join a Medicare Advantage Plan, you are still in Medicare.

Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage and must cover medically necessary services. They generally offer additional benefits, and many include Part D prescription drug coverage. These plans often have networks, which means you may have to see the plan’s doctors and go to certain hospitals to get care.

medicare part c

Medicare Advantage Plans can save you money, since out-of-pocket costs in these plans are generally lower than with Original Medicare alone. However, your cost will vary by the services you use and the type of policy you purchase. Each Medicare Advantage Plan can charge different out of pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan).

Plan options can include:

  • Preferred Provider Organization (PPO)
  • Health Maintenance Organization (HMO)
  • Private Fee-For-Service (PFFS)
  • Special Needs Plans (SNP)
  • Medical Savings Account (MSA)

You can generally join if:

  • You live in the service area of the plan you want to join
  • You have Medicare Part A and Part B coverage
  • You don’t have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)

Changes you can make:

If you are enrolled in Medicare Advantage, you take advantage of two Medicare enrollment periods: Medicare Advantage Open Enrollment (January 1 – March 31) and the Annual Enrollment Period (October 15 – December 7).

During the Medicare Advantage Open Enrollment Period, you can:

  • Go back to Original Medicare and join a Part D prescription drug plan (if needed)
  • Switch to another Medicare Advantage plan (with or without drug coverage)

During the Annual Enrollment Period, you can:

  • Drop Medicare Advantage and go back to Original Medicare (or vice versa)
  • Switch to another Medicare Advantage plan (with or without drug coverage)
  • Join, switch, or drop a Part D prescription drug plan

Still have questions, or need more information on how to pick the plan that is right for you?

The Benefit Link is here to help! Give us a call and speak to a licensed insurance agent: