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Medicare Part C

Explanation of Medicare Part C

When considering your Medicare options, it is easy to get confused and overwhelmed. Relax and take one section at a time to gain an overall understanding. Knowing what Medicare is and how it works will help you to make the best decision. One option is called Part C, or Medicare Advantage Plan (like HMO or PPO).

What is Part C?

Medicare Part C combines your Part A and Part B options and must cover all medically needed services. The difference is that private insurance companies that are approved by Medicare provide this type of coverage. In most cases, Part C is a lower-cost alternative to the Original Medicare Plan, and providers usually offer extra benefits and include prescription drug coverage (Part D).

Part C plans often have networks, and you must use the doctors or hospitals that belong to the plan. These plans help you coordinate and manage your overall care. Part C includes specialized care for people who need a large amount of health care services. If you find yourself needing medical attention while traveling out of your plan coverage area, you will still be covered for emergency or urgent care services.

What Medicare Advantage (Part C) Plans are available?

There are several plans available for Medicare Advantage. The Part C plans include the following:

*Medicare Preferred Provider Organization (PPO) – You are able to see any doctor or specialist that you choose. If they are not in your PPO network, your cost will increase. You usually can see a specialist without a referral.

*Medicare Health Maintenance Organizations (HMO) – You are able to visit doctors in the HMO network only. In most cases, you will be required to have a referral to visit a specialist.

*Medicare Private Fee-for-Service (PFFS) – You are able to see any doctor or specialist, but they must be willing to accept the PFFS’s fees, terms, and conditions. You do not have to have a referral to see a specialist.

*Medicare Special Needs – These plans are designed for people with certain chronic diseases or other special health needs. These plans must include Part A, Part B, and Part D coverage.

*Medicare Medical Savings Account (MSA) – There are two parts to this plan:

(1) A high-deductible plan with which coverage won’t begin until the annual deductible is met.

(2) A savings account plan where Medicare deposits money for you to use for health care costs.

Do You Need Prescription Drug Coverage?

Most Part C plans already include prescription drug coverage (Part D). If your plan offers drug coverage, you have to take it. If you have a stand-alone drug plan, and your Medicare Advantage Plan already has one, you will not be able to keep the Part C coverage. If you already have a prescription drug coverage, then you may choose a plan that does not have the drug plan included.

Eligibility for Part C

If you join Part C, you will still be in the Medicare Program and will have complete Part A and B coverage. You will continue to have Medicare rights and protection and in most cases, you will have prescription drug coverage (Part D) included as well.

You can join Part C if you reside in the service area where you wish to join, if you already have Medicare Part A and B, and if you do not have End-Stage Renal Disease (with minor exceptions).

Part C is really not that complicated once you understand it all. Before you decide to get health care insurance, it is a good idea to make sure you have a clear understanding of the coverage and premiums. This is not guesswork; don’t be afraid to ask questions. A Medicare representative can help you find the answers.