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Medicare Part C

Medicare Advantage plans, or Part C, are private health insurance options in addition to Original Medicare (Part A and Part B). These plans are approved by Medicare but offered by private health insurance carriers. Typically, Medicare beneficiaries pay a monthly premium in addition to their Part B monthly premium to cover services that are not covered by Original Medicare. In most cases, Medicare Advantage Plans include Prescription Drug Coverage (Part D) at an extra cost.

Medicare Advantage plans help to pay for services such as:

  • Dental Care
  • Gym or Health Club Memberships
  • Hearing
  • Prescription Drugs
  • Vision Care

Medicare Advantage Plans include all of your Part A (Hospital Insurance) and Part B (Medical Insurance). This means they cover all the services that both Parts A and B provide as well as additional services not provided by Original Medicare.

There are a few types of Medicare Advantage plans. These include:

  • Preferred Provider Organization (PPO) - a PPO allows you to see any doctor you wish, you do not need to designate a primary care physician, and you can usually see any specialist without a referral. Though it offers choice and flexibility, it is usually more expensive. In most cases, prescription drugs are covered.
  • Health Maintenance Organization (HMO) - HMOs require you to see doctors and hospitals in their list of providers. You generally are required to choose a primary care physician. In most cases, prescription drugs are covered.
  • Private Fee-For-Service (PFFS) - With a PFFS plan you can see any doctor as long as the doctor is willing to accept the plan. Some plans offer drug coverage. If your PFFS plan does not, you can join a Medicare Prescription Drug Plan (Part D).
  • Medical Savings Account (MSA) - MSAs are plans with accounts in which tax-deferred deposits can be made for medical expenses. They combine a high deductible health plan with a bank account. Money spent for Part A and Part B services counts towards your plan's deductible. MSAs do not cover prescription drugs. You can join a Medicare Prescription Drug plan to get drug coverage.
  • Special Needs Plans (SNP) - SNP plans are targeted to enrollees identified as either institutionalized, dually eligible for both Medicare and Medicaid, and/or with sever or disabling chronic conditions. All SNPs much provide prescription drug coverage and you must get your care and services from doctors or hospitals in the plan's network.

You can join a Medicare Advantage Plan if you meet the following eligibility requirements:

  • You must have Medicare Part A and Part B
  • You must live in the service area of the plan
  • You don't have End-Stage Renal Disease

You can Join, Drop or Switch Medicare Advantage Plans at any of the following times:

  • 3 months before to 3 months after your 65th birthday
  • 3 months before to 3 months after the 25th month of disability
  • Between November 15 and December 31 of each year with coverage beginning on January 1
  • Between January 1 and March 31 of each year. Unfortunately, you cannot join or switch to a plan with prescription drug coverage during this time period unless you already have a Medicare prescription drug plan (Part D)