What is Medicare Part C?
Medicare Part C, more commonly known as Medicare Advantage, allows private health insurance companies like Priority Health to offer Medicare benefits beyond what is covered by Parts A and B. These plans can include Health Maintenance Organizations (HMOs), Point of Service (POS) plans and Preferred Provider Organizations (PPOs). When these plans include prescription drug coverage from Part D, they are referred to as MAPD plans. In essence, Medicare Advantage plans provide all the benefits of Original Medicare, plus additional features and services.
Why enroll in Medicare Part C?
Medicare Advantage can help lower your out-of-pocket costs with predictable copayments, lower deductibles and out-of-pocket maximums. In addition to helping cover prescription drugs, MAPD plans can also offer extra benefits, such as gym memberships or dental coverage.
What does Medicare Part C cover?
Coverage under Part C is very similar to that of a typical health insurance plan, however it also offers dental, vision and other coverage benefits that may not be found in Parts A and B.
How much does a Medicare Part C plan cost?
Medicare plan costs can vary from person to person. If you think a Medicare Advantage plan may be right for you, you should thoroughly consider your financial position.
Advantage plans tend to be a great option for those who are eligible for Medicare and looking to save money each month, but tend to have lower coverage needs. Generally, with any health insurance plan, the lower the premium, the higher the deductible. Since many Advantage plans offer a $0 premium, you might end up paying more out-of-pocket, especially when considering costs like prescriptions.
Eligibility for Medicare Part C
If a Medicare Part C plan seems like the right choice for you, you can follow the standard application process. However, keep in mind that the usual Medicare enrollment requirements still apply. You must:
- Have both Medicare Part A and Part B to enroll.
- Be a permanent Michigan resident and reside in our service area for at least six months of the year.
You can't be denied for pre-existing conditions unless diagnosed with end-stage renal disease (ESRD).
When can you enroll in Medicare Part C?
You can enroll in Medicare Part C during any of the following periods:
Initial enrollment period (IEP). IEP is the seven-month period that begins three months before your 65th birthday and enrollment in Parts A and B. During this time, you can elect to have just Original Medicare (Parts A and B) or add extra coverage with a Medicare Advantage or Medigap plan.
Annual election period (AEP). The annual election period runs from October 15 to December 7 each year. During this time, you can make necessary changes to your supplemental Medicare coverage, reevaluate your current and future health care needs, and ensure your plan is a good fit for the upcoming year.
You can also change to a different Medicare Advantage or MAPD (with Part D) plan or return to Original Medicare, provided you were previously enrolled in an Advantage or MAPD plan.
Special enrollment period (SEP). These are periods outside of the IEP or AEP when an individual can change their current plan. Some examples are:
- If you move outside the plan's service area
- If you are enrolled in both Medicare and Medicaid
- If you qualify for a low-income subsidy
- If you lose creditable drug coverage from your employer
- If your plan is no longer offered
- If your plan is terminated by Medicare
What is covered under Medicare Part C?
If you purchase Part C through a private insurer, you’ll receive coverage for any covered inpatient or outpatient care.