Medicare Part C, also known as Medicare Advantage, is a way to receive your Part A and B Medicare benefits while also having access to Part D prescription benefits – all in one plan. Part C plans are a convenient way to plug the gaps that Medicare doesn’t cover, without having to pay a large monthly premium like you would with a Medicare Supplement plan.
Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.
Who is eligible for Part C?
If you are enrolled in both Medicare Part A and Part B, live within the plan’s service area, and can pay the required monthly premium – you’re eligible for a Medicare Advantage plan in Ohio. You cannot have both a Medigap (or Medicare Supplement) plan AND a Medicare Advantage (or Part C) plan at the same time. In fact, it’s illegal for an agent or broker to try to enroll you in both types of plans at the same time.
What is covered under Part C?
A Medicare Advantage plan cover the gaps, similar to a Medicare Supplement plan, except it also incorporates drug coverage or Part D into one convenient plan. Many Advantage plans offer extra coverages not included in Original Medicare. In contrast, retirees on a Medicare Supplement or Medigap plan have to juggle three or four companies at once if they want prescription drug coverage, dental and vision insurance in addition to their Medigap plan. Please note Medicare Advantage plans and Medicare Supplement plans are completely different types of plans.
How much does Part C cost?
Part C or Medicare Advantage plans can range in price. Usually the premium per month plans are available near heavily populated metropolitan areas, while the same plan may have a small monthly premium out in rural areas. Generally, the lower the premium, the more restrictive or smaller the network, compared to Part C plans with larger monthly premiums, that may have larger national PPO networks.
Aside from the monthly premium, there are three costs to consider with a Medicare Advantage plan: deductibles, copays and coinsurance. While Medicare Advantage plans offer one single plan deductible that covers both Part A and Part B benefits, you may have to pay additional coinsurance and copays for doctor and medical provider visits.
One big risk of a Medicare Advantage plan is the maximum out-of-pocket cost that a retiree could incur in any given year – IF you use the plan’s network doctors and hospitals. Retirees who go outside the network may pay double that. This out of pocket cost doesn’t include your prescription drugs, which may also have a separate deductible than your plan deductible.
When can I enroll in Part C?
Retirees can enroll in a Medicare Advantage or Part C plan when they first turn 65 years old and enroll in both Medicare Part A and Part B, also known as the Initial Enrollment Period (IEP). They can also enroll in Part C when they go onto Medicaid, come off Medicaid, get public assistance, or come off group health insurance. If you’re not in any of those Special Enrollment Periods (SEP), you can wait until the Annual Enrollment Period (AEP), which goes from October 15 to December 7, when you can enroll in a plan for the following year beginning January 1st.
How do I enroll in Part C?
Enrolling in a Medicare Advantage plan is easier than a Medicare Supplement because there are no health questions to answer. You can either apply by submitting a paper application, going online to fill out an electronic application or applying over the phone with your agent or broker. Once your application is processed, your plan materials and ID cards will be sent to you in 7-10 business days.
