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Part C usually offers A, B, and D in one plan and is offered by private insurance companies. Part C is also known as Medicare Advantage.
Learn about the four parts of Medicare:
Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Managed Care Plan, and formerly known as Medicare+Choice, is the part of Medicare concerning private health plans. It lets you get your Medicare benefits from a private health plan contracted by the government to provide this coverage. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs and coverage restrictions. Some plans (MAPDs—Medicare Advantage Prescription Drug Plans) offer Part D drug coverage as part of their benefits packages. You must have Medicare Part A and Part B to join a Medicare Advantage Plan. Medicare Advantage Plans include HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), PFFS (Private Fee-for-Service) plans, SNPs (Special Needs Plans) and MSAs (Medical Savings Accounts), and may have a POS (Point-of-Service) option.
Before you choose to enroll in a Part C (private Medicare Advantage or MA) health plan, you should check to see what costs you may have. These costs may include:
In 2022, the average monthly MA plan premium is $19 per month according to the Center for Medicare and Medicaid (CMS), but this premium may vary significantly between plans, anywhere from $0 to over $100. Remember that you must have Medicare Parts A & B to join a Medicare Advantage plan.
You pay your usual Part B premium plus any additional premium that the plan may charge. Some MA plans may pay a portion of your Part B premium; check with the plan to see if this is the case.
Only some Medicare Advantage Plans have an annual deductible, in addition to the standard Part B deductible. Plans that include prescription drug coverage may charge another deductible for drug coverage.
Copayments are for specific services, such as doctors’ visits. Usually copays are a flat dollar fee, unlike the coinsurance percentage of traditional Medicare. Some types of plans charge higher copays to see providers out of your network.
Each year, plans establish the amounts they charge for premiums, deductibles and services. Each Part C 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 for non-emergency or non-urgent care).
These rules can change each year, but what you pay may change only once a year, on January 1. For current Medicare beneficiaries, the maximum out-of-pocket spending limit is $6,700 in 2019. If you use out-of-network providers, the limit may be higher. Some plans offer an out-of-pocket limit below the $6,700 maximum.
Special Needs Plans (SNPs) are Part C plans for people with Medicare who:
If you have both Medicare and Medicaid, most of your costs will be covered by those programs. If you don’t have Medicaid or get help from other programs (such as Medicare Savings Programs), your costs may be similar to what you would pay in a regular Medicare Advantage plan.
Under Original Medicare, inpatient care is generally covered by Medicare Part A. Medicare Part C covers the same benefits as Medicare Part A including:
Medicare Part C may have different cost sharing amounts for inpatient care and home health care than Original Medicare has. With Medicare Advantage, your hospice care benefits will still be covered by Original Medicare.
Under Original Medicare, outpatient care is generally covered by Medicare Part B. Outpatient care includes medically necessary services and preventive services to prevent or detect disease. Medicare Part C covers the same benefits as Medicare Part B including:
Medicare Part C may have different cost sharing amounts for outpatient care than Original Medicare has.
Unlike Original Medicare, Medicare Part C generally offers coverage for prescription drugs you take at home. The exact prescription drugs that are covered are listed in the plan’s formulary. Formularies may vary from plan to plan.
Other extra benefits that Medicare Part C may cover include:
Not all Medicare Part C plans cover extra benefits in the same way. For example, some Medicare Part C plans may only cover “Medicare-covered dental benefits” which generally only means dental care in the event of an accident or disease of the jaw. If your Medicare Part C covers dental benefits more extensively, you may have a higher monthly premium for that coverage.
If you are denied coverage for something you need, the first thing you may be able to do is file an appeal. You can appeal for a health care service, supply, item, or prescription drug that you think you should be able to get or that you already got. You also can appeal to pay less than you originally were requested to pay.
If your appeal is denied or if you have other frustrations with your plan, you can switch Medicare Advantage plans during the Annual Election Period (AEP) which is October 15 – December 7 every year.
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Aetna – Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
Anthem Blue Cross – Anthem Blue Cross is an HMO plan with a Medicare contract. Enrollment in Anthem Blue Cross depends on contract renewal.
Cigna – Cigna-HealthSpring is contracted with Medicare for PDP plans, HMO and PPO plans in select states, and with select State Medicaid programs. Enrollment in Cigna-HealthSpring depends on contract renewal.
Humana – Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal.
Molina Healthcare– Molina Healthcare is contracted with Medicare for HMO and PPO plans in select states, and with select State Medicaid programs.
Prominence Health Plan – Prominence Health Plan is an HMO Plan with a Medicare contract. Enrollment in Prominence Health Plan depends on contract renewal.
SCAN Health Plan –SCAN Health Plan is an HMO Plan with a Medicare contract. Enrollment in SCAN Health Plan depends on contract renewal.
SelectHealth – SelectHealth is an HMO, HMO-SNP plan sponsor with a Medicare contract. Enrollment in SelectHealth Advantage depends on contract renewal.
Senior Care Plus – Senior Care Plus is a Medicare Advantage organization and a stand-alone Prescription Drug Plan with a Medicare contract. Enrollment in Senior Care Plus depends on contract renewal.
UnitedHealthcare – Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare.
WellCare – Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract, and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.