Medicare Part C
Looking for an alternative to Original Medicare?
You might discover that Original Medicare doesn’t provide coverage for everything you need or want with your healthcare benefits. If you’re looking for additional coverage, a Medicare Advantage plan, also referred to as Part C, might be an alternative to consider.
What is Medicare Advantage?
Medicare Advantage, which is not a part of Original Medicare, is an alternative option for those who want more coverage than what Part A and Part B offer.
Medicare Advantage plans are operated by private insurance companies that not only provide benefits that meet or exceed those found in Original Medicare, but also cover those additional out-of-pocket costs that you are charged. It is a plan that bundles together Part A, Part B and usually Part D.
Medicare Advantage plans have a network of providers, which consist of doctors, pharmacies, hospitals and other healthcare services that are approved by the private insurance companies. The plan designs include HMOs, PPOs, POS, PFFS and MSAs.
Medicare Advantage has specific service areas, so it’s important that you research what plans are available in your county before enrolling.
Why Was Medicare Advantage Created?
After 40 years of existence, Medicare introduced an alternative to Original Medicare. With the rising costs associated with operating Original Medicare, programs were needed that would provide improved outcomes with lower costs.
As a result, Congress passed the Medicare Modernization Act of 2003 which created Medicare Advantage plans. The act was initially designed to create universal prescription drug entitlement; however, it also replaced Medicare Choice Plus (Part C) with Medicare Advantage as an alternative to Original Medicare and Medigap.
What does Medicare Advantage Cover?
Medicare Advantage provides the same benefits found in Original Medicare, with the exception of Hospice, which is still covered under Part A. Medicare Advantage may also offer benefits above and beyond those offered by Original Medicare.
The Pros and Cons of Choosing a Medicare Advantage Plan
By selecting a Medicare Advantage plan, you may receive additional benefits above and beyond those offered with Original Medicare. However, there are some restrictions that are worth mentioning as well.
Please carefully research all your options, including Medicare Advantage, before deciding on the benefit plans best suited for your situation.
✓ A fixed out-of-pocket maximum.
✓ Networks of credentialed providers, which includes doctors, pharmacies, hospitals and other healthcare services.
✓ The freedom of choice every year to switch your plan during the Annual Enrollment Period.
✓ Lower number of medical providers.
✓ The need for prior authorization for certain procedures.
✓ It sometimes isn’t compatible with other forms of retiree coverage.
Medicare Advantage Costs
Medicare Advantage plans will have out-of-pocket expenses, such as copays, deductibles and coinsurance when you access medical services through your plan. Original Medicare will also have similar out-of-pocket expenses, though enrolling in a Medicare Supplement plan will help offset many of these costs.
To join a Medicare Advantage plan, you must have Medicare Parts A and B. You are still responsible to pay for your Part B premiums, plus any additional premium that the plan may charge. You also must live in your plan’s service area.
When Can You Enroll in Medicare Advantage?
There are three opportunities to enroll into Medicare Advantage:
✓ During your Initial Enrollment Period (IEP) when you turn 65. This is the 7-month window that surrounds your 65th birthday. During this enrollment period, you can sign up for a Medicare Advantage plans with or without Prescription Part D coverage.
✓ If you delayed your Part B enrollment due to having employer coverage, you can elect to enroll into Medicare Advantage under a Special Enrollment Period (SEP). To learn more about Special Enrollment periods, please go to our Special Enrollment Period – Working Past 65 page.
✓ Finally, for those already on Original Medicare and desire to switch to Medicare Advantage, Medicare offers an Annual Enrollment Period (AEP) where individuals can make this change. AEP runs from October 15 through December 7 each year and also provides you the opportunity to change plans or drop your Medicare Advantage plan. To learn more about the Annual Enrollment Period, please visit our Annual Enrollment Period page.
✓ A Medicare beneficiary can choose either a Medicare Supplement or a Medicare Advantage plan, but they cannot elect both.
✓ To be eligible for a Medicare Advantage plan, you must live in the plan’s service area.
✓ Medicare Advantage plans have provider networks from whom you can access care. Inquire if referrals are needed to navigate through their network of providers.
✓ Before purchasing an Advantage plan, please ask your agent to perform a provider search to confirm that your medical providers are accessible through their plans.
✓ Medicare Advantage coverage can include prescription coverage, so please have your agent evaluate your prescription list to identify the levels of coverage and costs by selecting an Advantage plan.
Understanding Medicare Advantage
We understand that the differences between Original Medicare and Medicare Advantage can be confusing, and our agents are ready to assist you in all phases of the Medicare decision process. Whether online, over the phone or in person, helping you obtain the information you need is our priority.