Did you know that as of April 2022, more than 28 million people are enrolled in Medicare part C, also known as a Medicare Advantage plan? Medicare part C is an additional insurance option you can consider once you’re eligible for Medicare.
Keep reading this guide to learn everything you need to know about Medicare part C.
An Overview of Medicare
Medicare can be a confusing topic for many people. So, it’s important to start with the basics of the different Medicare plans you can select.
Original Medicare includes parts A, B, and D. Medicare part A covers things like hospital care, skilled nursing facilities, home health care after hospitalization, and hospice care.
Medicare part B covers things like durable medical equipment, preventive services, therapy services, x-rays, and lab tests.
Finally, you can purchase Medicare part D separately, which provides coverage for prescription medications.
What Is Medicare Part C?
Medicare Part C (Medicare Advantage) is another option for people who are eligible for original Medicare.
Medicare-approved private insurance companies offer different Medicare Advantage plans you can choose from.
Remember, with original Medicare, you’ll get coverage for both part A and part B. Medicare part C offers coverage for the same services provided under parts A and B.
However, Medicare part C also gives you options to buy coverage for services like:
- Dental care
- Vision care
- Hearing aids
- Home meal delivery after you’ve been in the hospital
- Prescription medications
- Gym memberships
- Transportation to your doctor’s appointments
Types of Medicare C Plans
If you already have coverage through a health insurance company, you can check to see if it offers Medicare C coverage.
Many major insurance companies offer Medicare C plans, and there are different types of Medicare C plans that you can take advantage of. The most common Medicare plan options include:
Medicare Advantage HMO Plans
Health Maintenance Organization plans or HMO plans are a good choice if your preferred doctor is a part of the plan network since you’ll need to select a primary care physician.
With HMO plans, you’ll have to see healthcare professionals and use hospitals that are in your plan’s network. You also typically need a referral to see a specialist.
Medicare Advantage PPO Plans
The Preferred Provider Organization or PPO plan is another Medicare part C healthcare plan option that gives you more freedom in choosing your doctors.
With PPO plans, you’ll get to choose from a list of preferred doctors, specialists, and hospitals. You can also see a specialist without needing a referral.
Special Needs Plans (SNPs)
Medicare part C special needs plans were also created to help people with additional healthcare needs.
These types of plans include Medicare part D coverage for prescriptions and extra services you might need to manage your health condition.
You’ll need to prove you qualify for SNPs by a medical diagnosis or your income. SNPs are also broken down into groups which include:
- Chronic condition special needs plans (C-SNPs) are for conditions like cancer or heart failure
- Institutional special needs plans (I-SNPs) are for people in a medical facility for over 90 days
- Dual Eligible SNPs (D-SNPs) offer coverage for people who are eligible for both Medicare and Medicaid
Medicare Part C Eligibility
To be eligible for Medicare Part C, you’ll need to qualify for original Medicare. To qualify, you’ll need to be 65 years or older and a United States citizen.
Additionally, if you’ve been receiving Social Security disability benefits for at least 24 months, you can enroll in Medicare anytime, no matter how old you are.
If you have ALS (amyotrophic lateral sclerosis), you can enroll in Medicare as soon as you collect Social Security disability benefits.
Also, if you have ESRD (end-stage renal disease), you’re eligible for Medicare between 1 and 4 months after you start dialysis, depending on the type of dialysis you receive.
You’ll need to be enrolled in original Medicare parts A and B first and also need to live in a Medicare Advantage plan service area.
Medicare Part C Enrollment
Since you first need to enroll in original Medicare parts A and B, you’ll need to enroll in that first. You’ll then be able to choose a Medicare Advantage plan with a private insurer.
You can enroll online or contact your local Social Security office to sign up.
If you’re 65, you can enroll between three months before your 65th birthday and three months afterward.
This is known as the initial enrollment period. It’s important to remember to enroll during this period, as you can face penalties if you wait.
If you miss the initial Medicare enrollment period on your birthday, you can enroll during general enrollment.
General enrollment for Medicare runs from January 1 to March 31 every year. You can also make changes to your Medicare Advantage plan during the open enrollment period between January 1 to March 31.
Special Enrollment Period
Certain life events also allow you to switch your Medicare Advantage plan options, such as:
- Moving out of your plan’s service area
- Moving back to the United States
- Moving out of a long-term care facility
- Losing employer health insurance
- Being released from jail
- Losing Medicaid eligibility
- Becoming eligible for both Medicare and Medicaid
It’s best to check Medicare.gov to see if your situation might qualify you for a special enrollment period and how long you have to make these changes.
Understanding Your Medicare Part C Options
There is a lot you need to know about enrolling in Medicare part C, so don’t hesitate to contact the Medicare helpline at 1-800-633-4227 if you have questions about how Medicare benefits work.
This helpline is open 24-7, except on Federal holidays.
Next, it’s also a good idea to compare prices and plans based on your budget and any special needs that you might have.
Make sure you start the process a few months before you enroll to give yourself time to understand all your Medicare options completely.