Medicare Part C

By: Edward Neeman
Published: Wednesday, July 25 2018
Last Updated: 4 years ago

Choosing a healthcare plan that fits with your needs and budget can be daunting. Medicare alone contains a handful of different types of coverage. If you are interested in Medicare Part C, then the information below will help you learn more about the program such as eligibility requirements and benefits. That way, you should have a clearer picture about Part C Medicare and whether or not it is the ideal choice for you.

What is Medicare Part C

Researching the coverage options available under Medicare can take time as not everyone is aware of the distinction between the various plans. The biggest question then is what is Medicare Part C? To put it plainly, it is a Medicare option that is run by private companies and offers the benefits of both Part A and Part B coverage.

You may often see Part C Medicare referred to as Medicare Advantage, and both ways are correct as they are one in the same. Depending on your situation, Medicare Part C coverage can be a good alternative to get the best of both Part A and Part B benefits, along with some additional healthcare benefits.

Who is Eligible for Medicare Part C

In most cases, as long as you are eligible for Medicare Part A and Part B, you can receive Medicare Part C coverage. There is a general breakdown of the requirements needed:

  • You must be enrolled in Medicare Part A and Part B
  • You have to live in a service area of a Medicare Advantage insurance provider
  • You cannot have End-Stage Renal Disease (ESRD)

Another important thing to note about Part C is that you cannot be enrolled in both Medicare Supplemental plans and Medicare Part C plans. It must be one or the other.

How Medicare Part C Works

A good way to comprehend what is Medicare Part C is going through the details about how it works. To repeat what was mentioned earlier, Medicare Part C benefits include the benefits received from Part A and Part B. Which means you will get both hospital insurance and medical insurance. In addition to that, however, is the potential to receive a host of other benefits not offered in Original Medicare.

With Part C Medicare, Medicare will pay a fixed amount each month to those companies that offer Medicare Part C plans. Since you are still under the Medicare program, your rights remain the same, and the companies involved must adhere to the rules.

What makes Medicare Part C stand out from the other plans is that it contains several different insurance companies you can choose from. In most cases, the Medicare Part C plans have specific provider networks. That is why it is good to search through the various plans and accompanying insurance companies to discover what type of Medicare Part C coverage works best for your situation.

To touch more on the Medicare Part C plans, you can generally choose from the following:

Each of these Medicare Part C plans has different stipulations, costs, and Medicare Part C benefits.

Health Maintenance Organization (HMO) Plans: With most HMOs, you will only receive Medicare Part C coverage if you visit doctors, hospitals, and specialists that are in the HMO provider network. This is true except in the case of emergencies. You are usually required to have a referral for specialists and choose a primary care physician. For prescription drugs, in most cases, they are covered.

Preferred Provider Organization (PPO) Plans: Under a PPO plan, you will pay a lower cost if you decide to use healthcare providers in the PPO network. If you choose to go outside of the network, then you will pay an additional cost. When it comes to referrals to see specialists, you generally don't need one. You do not need to choose a primary care physician. As for prescription drug coverage, some plans offer it.

Private Fee-for-Service (PFFS) Plans: Using a PFFS, you can go to any healthcare provider that accepts Medicare payment. The difference with this plan is that the insurance companies themselves decide how much they will pay and how much you will pay rather than Medicare deciding that. No referrals for specialists are needed, and you don't have to have a primary care doctor. Prescription drugs may or may not be covered.

Special Needs Plans (SNPs): Getting this type of Medicare Part C coverage is limited to specific individuals with certain diseases like chronic conditions or situations like living in a nursing home. In most cases, you need referrals for specialists and have a primary care doctor. Prescription drugs are covered under this plan. Your Medicare Part C benefits are tailored around your health.

HMO Point-of-Service (HMOPOS) Plans: This is an HMO option that offers you the chance to use providers outside of the network by paying an additional cost.

Medical Savings Account (MSA) Plans: Using an MSA means you will see a higher deductible. This high deductible is combined with your bank account. You will only get Medicare Part C coverage once you have met the yearly deductible put in place. Medicare will deposit money into your bank account that you can use for your healthcare coverage before you are able to meet the deductible.

Who Should Consider Medicare Part C

Having answered the question about what is Medicare Part C, it's time to consider who should enroll. In most cases, with Medicare Part C coverage, you'll see either low monthly premiums or no premiums at all. So, if you are interested in that, then you should consider a Medicare Advantage plan.

If you are in need of the benefits offered by Part A and Part B in addition to having more options, then Part C Medicare can be an ideal choice. Also, there are many Medicare Part C benefits that you cannot find under Original Medicare.

Lastly, if you require prescription coverage, then Medicare Part C plans may benefit you. Many of the plans come with that. So, as long as you choose the appropriate plan, your Medicare Part C benefits will include prescription coverage.

Enrolling in Medicare Part C

Knowing when you can enroll in Medicare Part C is just as important about understanding the program in general. Usually, you can get into Part C Medicare by signing up during the enrollment period.

If you are completely new to Medicare, then you can enroll when you first become eligible. This is a 7-month period that begins three months prior to your 65th birthday. It includes your birthday month as well as three months after.

For those under 65-years-old who is eligible for Medicare due to disability, you can enroll during the following 7-month period: three months before your 25th month of receiving your disability benefits, the 25th month of benefits, and the three months after the 25th month.

Find A Medicare Part C Plan With FirstQuote Medicare

By now, you hopefully a greater understanding as to what is Medicare Part C so that you can decide if it is the right path for you and your health requirements. If you have decided to go with the program, then you can use FirstQuote Medicare to find a Medicare Part C quote and compare your options.