Medicare Part C – Medicare Advantage

What is Medicare Part C – Medicare Advantage Plan?

Medicare Part C, also known as Medicare Advantage, is administered by private insurance companies contracted by the federal government. These plans are provided by privately insured carriers to individuals with both Medicare Part A and Medicare Part B. A simple way to remember Medicare Part C is that they combine Part A + Part B + Part D (sometimes they do not offer Part D) = Part C/Medicare Advantage. It is important to remember that these plans MUST offer you the same amount of coverage as original Medicare (Part A + Part B) or exceed it. They can not offer you less coverage by law. Therefore, you will see Medicare Part C/Medicare Advantage plans offering you extra benefits to not only meet government guidelines on Medicare but exceeding it. 

You do not enroll in a Medicare Part C/Medicare Advantage Plan with the government but with a licensed professional such as a Coverage2Care broker. With the government you only enroll in Part A and Part B.  This means, you do not enroll for an Medicare Advantage (Part C) plan at the Social Security office; instead, you’ll need to speak with a Coverage2Care agent to enroll.

Medicare Advantage plans come in both HMO and PPO policies and can vary depending on your geographic location. Make sure to speak with a Coverage2Care agent to check availability in your area for Medicare Advantage plans as they vary from county to county. 

A Medicare Part C/Medicare Advantage Plan is NOT a Medicare Supplement/Medigap plan. 

What does Medicare Advantage cover?

You will still be enrolled in Original Medicare under a Medicare Advantage Plan; and enjoy those same benefits however, Medicare Advantage plans may offer certain benefits that Original Medicare doesn’t cover, such as: 

  • Dental coverage
  • Vision/hearing coverage
  • Caregiver counseling and training
  • Housekeeping
  • Over-the-counter drugs
  • Prescription drug coverage
  • Fitness memberships
  • Nutrition programs
  • Services and support for chronic conditions
  • Transportation to doctor visits
  • Wellness programs

How Much Does Medicare Advantage Cost?

Medicare Advantage Plans cost rates vary depending on where you live. In general, you can find Medicare Advantage (Part C) plans starting at $0 per month in major cities in both HMO and PPO options.

You generally have co-pays associated with Medicare Advantage plans when services are rendered such as a specialists visit or emergency room visits.

Please speak to a Coverage2Care agent to see what is available in your area and costs associated with Medicare Advantage (Part C).

Is there a deductible for Medicare Advantage Part C?

It varies on your specific Medicare Advantage Plan (Part C). Some plans may offer no deductibles while others may offer only a deductible for going out-of-network.

Your Coverage2Care agent will be able to assist you with telling you exactly if there is any deductible associated with your Medicare Advantage plan.

10 Important things to know about Medicare Part C or Medicare Advantage Plans

1.) You must continue to pay your Medicare Part B premium every month

Medicare then gives your premium to your private carriers Medicare Advantage plan to help pay for your additional coverage. But every person on Medicare must continue to pay their monthly Part B premium. That never goes away unless you have extra assistance such as Medicaid or LIS/Extra Help. 

2.) Joining a Medicare Advantage plan may affect your current coverage

If you have existing coverage or employer-provided health insurance and plan to work past 65, check to see how joining a Medicare Advantage plan could affect or cancel your current coverage.

3.) Use network providers

Use of network health care and pharmacy providers is typically required.

Using providers outside of the network may cost you more.

In an emergency, you can use any provider.

4.) Financial assistance

Depending on your financial situation, you may qualify for help paying your plan premiums or Part D medication (low-income subsidy / Extra Help).

5.) Part D late-enrollment penalty

This is an additional amount charged by Medicare that will be added to your Part D premium if you go without Part D coverage for longer than 63 days in a row after your Initial Enrollment Period. Medicare Advantage plans that included

Part D coverage meet Medicare coverage requirements.

6.) A Medicare supplement insurance (Medigap policy) plan is not a Medicare Advantage plan

Medicare supplement plans are health insurance policies and are secondary to Original Medicare. Medicare Advantage plans combine Original Medicare Parts A and B, and sometimes Part D, into a single plan.

7.) You must use your member ID card

Members must present their member ID card, not their Original Medicare card, when receiving services.

8.) Medicare Advantage protections

Even though Medicare Advantage plans are privately administered, you still have the same rights and protections as with Original Medicare.

9.) Medicare Advantage has you covered

Medicare Advantage plans must cover all the services that Original Medicare covers and may offer additional benefits.

Important: Hospice care is still covered under Original Medicare.

10.) A built-in financial safety net

Your plan’s annual out-of-pocket maximum is your safety net that ensures you’ll never pay more than a certain amount out of pocket in a given plan year for covered medical services

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