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. Call us at 937.915.3563 or schedule a call.
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 feature extra benefits, such as dental, vision, hearing, fitness memberships, and more. 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.
Below are the standard benefits available on all Medicare Advantage plans compared to Original Medicare (Parts A and B).
Based on the plan offerings in your county, some Medicare Advantage plans may offer these additional benefits (shown below).
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. Many plans are available with a low or $0 premium. 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, or moving out of your plan’s area.
How to Sign Up for Medicare
If you are not automatically enrolled in Medicare, give us a call at 937.915.3563 and we'll help you understand the steps you need to take and your individual timeline. If you are coming off group coverage, you will want to be sure your Medicare effective date lines up 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
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. Compare your employer coverage to Medicare here.
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.
Email us at advice@retiremed.com, call us at 937.915.3563, or schedule an appointment to speak with an advisor.
Download Your 2024 Costs & Coverage Guide
We know how to make Medicare work for you.
Medicare can be complicated but we’re here to help. Let’s get started with the basics.