What is Medicare Part C?
Medicare Part C, also known as Medicare Advantage, covers both Medicare Part A and Part B, with additional benefits.
The Four Parts of Medicare
Medicare consists of four basic parts: Part A, Part B, Part C, and Part D. These different parts of Medicare help cover specific services. Depending on your situation, you can get Medicare coverage through a combination of these parts. Our advisors can help determine the combination of these four parts that is right for you.
What does Medicare Part C cover?
Medicare Part C is Medicare Advantage (MA) plans and must provide the same basic coverage as Medicare Parts A and B, but also provide additional benefits not covered by Original Medicare. Plans that include prescription drug coverage are referred to as Medicare Advantage Prescription Drug (MAPD) plans. Medicare Advantage plans also cap your out-of-pocket costs for covered services during the plan year.
Medicare Part C offers an alternative to Original Medicare (Parts A and B) for your health and drug coverage. Medicare Advantage plans are comprehensive plans offered by private insurance companies that are contracted and approved by Medicare. They offer plans that roll Part A (hospital-related), Part B (medical insurance), and often Part D (prescription drug) benefits into one plan.
Many individuals choose to enroll in a Medicare Advantage or Medicare Supplement (Medigap) plan to enhance and fill in the gaps that are not covered by Original Medicare.
Medicare Supplement plans are health insurance policies sold by private insurance companies, but they are a bit different than MA plans. Supplement plans are designed so that you pay a much higher monthly premium, which enables you to pay very little when you use your plan. They also lack the extra benefits generally covered by MA plans.
Types of Medicare Advantage Plans
MA plans come in multiple forms. The two most popular are HMO and PPO plans. By looking at your specific circumstances, we will assist you in choosing the plan that is right for you, based on your individual needs and budget.
HMO
An HMO (Health Maintenance Organization) features a network of approved doctors, hospitals, and other health care facilities. If you use an in-network doctor or hospital, it means the provider is approved by your plan. You will likely pay a lower rate for care. If you use an out-of-network provider, you will likely pay all of your medical bills, with the exception of emergency or urgent care visits. This is because the provider is not in your Medicare HMO plan’s network. While there are many other features to an HMO, the main thing to know is that they use networks to manage care and costs.
PPO
A PPO (Preferred Provider Organization) gives flexibility regarding the doctors you see and the health care facilities you use. PPO plans have a flexible network. If the doctor or facility is out of network, you will pay a larger portion of your medical bill.
How much do Medicare Advantage plans cost?
The amount you pay for a Medicare Advantage plan varies based on the plan you select and the benefits it includes. Regardless of the MA plan you choose, you must continue to pay your Part B premium. When you use Medicare Advantage services, you pay copays, co-insurance, and possibly deductibles.
Medicare Part C eligibility
To be eligible for Medicare Part C, you must be enrolled in Medicare Part A and Part B, and be a resident of the Medicare Advantage plan’s service area.
You must be a U.S. citizen or permanent legal resident for at least five consecutive years. You must also meet at least one of the following criteria for Medicare eligibility:
- Age 65 or older
- Are permanently disabled and have received disability benefits for at least two years
- Have been diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease)
When to apply for Medicare
Initial Enrollment Period
When you're first eligible for Medicare, you have a 7-month Initial Enrollment Period. If you are eligible for Medicare when you turn 65, you can sign up during the 7-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after you turn 65. We recommend contacting one of our expert advisors for Medicare advice approximately six months before you turn 65. Learn more about working past 65 and Medicare.
Special Enrollment Period
After your Initial Enrollment Period is over, you may have the opportunity to sign up for Medicare during a Special Enrollment Period (SEP) without having to pay a late enrollment penalty. These are granted due to special circumstances, such as losing or leaving employer coverage.
How to enroll in Medicare
If you are not automatically enrolled in Medicare, you can sign up for Original Medicare - Part A and Part B - via the online Medicare application, by calling Social Security at 800.772.1213, or by visiting your local Social Security office. Learn how to apply for Medicare here.
We encourage you to give us a call at 888.810.7633 and we'll help you understand the steps you need to take and your individual timeline. It’s important to know if you are coming off employer coverage, you will want to be sure your Medicare effective date aligns with the end of your other insurance coverage.
When can you enroll in a Medicare Part C plan?
• Initial Enrollment Period
• Special Enrollment Period
• Annual Enrollment Period (Oct. 15 – Dec. 7) when you can switch from Original Medicare to a Medicare Advantage plan; or you can switch from one MA plan to a different one
• Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) when you can change your Medicare Advantage plan to a different one
Navigating Medicare Part C: age-specific guidance
Choosing a Medicare Advantage plan can seem overwhelming, but with preparation and the right partner in Medicare, you will have everything you need to be successful. Here's a guide to simplify the process based on your age and situation.
- Confirm when you’re eligible for Medicare and if you qualify for early Medicare enrollment due to a disability or condition. Take our quiz to find out more.
- Get general Medicare education and answers to your questions by watching or attending one of our live or on-demand webinars.
- Learn about how and when to apply for Medicare.
- Need health coverage now? We offer individual health insurance plans to bridge the gap until you’re eligible for Medicare.
- Learn more about Medicare basics and download your turning 65 Medicare Checklist.
- Call or schedule an appointment with a RetireMed advisor to discuss your unique needs, plans for retirement or for working past 65, and other factors that will determine your specific next steps as they relate to Medicare and the enrollment process.
- Prepare for your appointment with RetireMed.
- Retirement isn’t a requirement to enroll in Medicare. If you’re working past 65, you have many factors to consider as you decide on your health coverage.
- Know specific steps to take and when with our checklist.
- Call or schedule an appointment with a RetireMed advisor to compare your existing coverage to Medicare.
- Navigating Medicare for a loved one can be overwhelming. Remember – we’re here to help answer questions and provide guidance!
- Find out when your loved one is eligible for Medicare and if they qualify for early Medicare coverage due to a disability or certain condition. They can take our quiz to learn more.
- Call or schedule an appointment for you and your loved one to meet with a RetireMed advisor to discuss your loved one’s unique situation.
Working past age 65 and Medicare enrollment
Retirement is not a requirement for enjoying the benefits of Medicare. Many individuals aged 65 and older are delaying retirement and staying in the workforce. If you’re working past age 65, you can sign up for Medicare regardless of your current employment status.
We make it easy to enroll in Medicare without retiring. Our advisors provide personalized guidance to help you choose the health plan that is right for you.
Questions? Your local partner in Medicare has answers.
If you have questions about your plan options, contact our team of advisors in Dayton and Cincinnati.