Of the four parts of Medicare coverage — A, B, C, and part D — part C is probably one that draws the most questions from the program’s participants. The reason is simple: Part C, also known as Medicare Advantage, involves health plans offered by private insurance companies that provide not only the same benefits as Parts A and B, but also additional coverage not available under those two parts.
In addition, beneficiaries will have to choose whether to go with Original Medicare (Parts A & B) or a Medicare Advantage (Part C) plan the moment they enroll in a Medicare health plan. This makes understanding the differences between what it offers all the more important. So if you are looking for information to help you make a choice, you have come to the right place.
Learn “What is Medicare Advantage Part C”, its benefits for your health, and how to enroll in it.
To understand the importance of Part C, let us first briefly explain the structure of Medicare. The below is a quick summary of what each part covers:
Part A: Hospital Insurance, including all inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home healthcare
Part B: Medical Insurance, including some doctors’ services, outpatient and preventive care, and medical supplies
Part C: Medicare Advantage Plan — an alternative to Part A and B and is offered by private health insurance providers
Part D: Prescription drug coverage, including the cost of prescription drugs, recommended shots and vaccines.
Parts A & B, also known as Original Medicare, are mandatory for people over the age of 65. The enrollment for Part A is free for most people while Part B requires a premium. The services they offer incur out-of-pocket costs.
Part C, on the other hand, refers to healthcare plans offered by private insurance providers approved by Medicare. These plans are seen as alternatives to Parts A & B as it provide not only the same benefits but also additional coverage than Original Medicare. Moreover, Medicare Advantage often includes lower out-of-pocket costs and lower premiums.
Medicare rules dictate that Medicare Advantage plans need to include benefits that are at least the same as Original Medicare (except for hospice care). So while all plans need to meet some requirement, they may differ in premium levels, copayments, deductibles, and other expenses, and also the area of coverage. For example, some plans may also cover prescription drugs, as well as vision, hearing, and dental services.
Another difference between Medicare Advantage and Original Medicare can be how you get services. Under the former, you may find yourself your choices of healthcare providers being limited to a specific network, while in some cases you may need a referral to see a specialist or physiotherapist.
For Original Medicare, which is offered by the Federal Government, the cost to each person is dependent on the income bracket he or she falls into. Medicare Advantage plans, on the other hand, can carry different features and scope of covered services for participants to choose from.
For Medicare Advantage plans, there are mainly four components:
Premiums: what users pay on a monthly basis
Deductibles: the set amount users pay out of their own pockets before the providers begin to pay for a service
Copays: the set amount users have to pay when they receive the service
Coinsurance: A percentage of medical costs a user is required to pay.
You may wonder why you should get Medicare Advantage if it costs more. Here are some good reasons:
Additional Coverage: Medicare Advantage plans usually come with prescription drug coverage and other medical services not covered by Original Medicare, such as vision and dental.
Variable Costs: The premium offered by different Medicare Advantage plans providers can vary, with some costing $0. Many Medicare advantage plans may even come with lower copayments and coinsurance than Original Medicare, as well as limiting out-of-pocket expenses.
Limited Liability: the out-of-pocket maximum of a Medicare Advantage plan can help limit your liability if you have a condition that requires regular and expensive treatments.
On the other hand, there are a few downsides to Medicare Advantage plans compared with Original Medicare
Limited Choice: some Medicare Advantage plans may restrict your choice of doctors and healthcare providers to within a specified network. Also, some plans may require referrals or authorization from your primary care physicians for certain services or operations, such as seeing a specialist.
Potential Higher Cost: Unlike Original Medicare, if you do decide to go out of their network for healthcare providers, you will most likely have to cover your own cost.
Geographical Limitation: Instead of the entire nation, the network of some Medicare Advantage plans may only be available within a specific region. So if you tend to switch between different locations, these plans may not be right for you.
To enroll in or make changes to a Medicare Advantage plan, you will have to wait for an enrollment period. The first opportunity called the initial enrollment period, varies depending on your birthdate and the timing of your enrollment in Original Medicare. Typically, it is a 7-month window that starts from 3 months before your birth month to 3 months after.
After that comes the open enrollment period, which runs from January 1 to March 31 every year. If you have an existing Medicare Advantage plan, you can use this period to switch to a different plan, or withdraw from Medicare Advantage and go back to Original Medicare.
For both these periods, coverage begins on the month following the month you enroll.
The last window is the annual enrollment period that runs from October 15 to December 7. For those who enroll during this period, coverage starts on the first day of the following year. During the annual enrollment period, you can switch from Medicare Advantage to Original Medicare, switch from Original Medicare to Medicare Advantage; and switch between Medicare Advantage plans.
In the case of certain qualifying events, such as losing your job, having changes in marital status, or having a child, you may also be eligible for a Special Enrollment Period outside of these periods.
Don’t miss out on the opportunity to fully understand the benefits available to you through Medicare. A licensed insurance agent is ready to guide you through your options, ensuring you make an informed decision that best suits your needs. This personalized service is provided to you entirely free of charge.
Contact a licensed insurance agent today and take the first step towards securing your peace of mind with the right Medicare plan.
