Medicare Advantage is a sort of All-in One option to standard Medicare. Medicare Advantage, also known as Part C, basically brings together various Medicare Plans but most often include Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and Medicare Part D (drug coverage) as well as the option to choose additional coverages to suit your unique needs.
Keep reading. We’re going to tell you everything you need to know about Medicare Part C coverage so you can make the best choice for you.
Our goal at ConsumerCoverage is to help you understand your options and help you get quotes and compare those options. Get informed, review your options, and choose a plan. We’ve Got You Covered!
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The first point of consideration is that Medicare represents two different health plans: Original Medicare and Medicare Advantage. So before you make any decisions, you should know the difference between your coverage options.
Original Medicare: Includes Part A (hospital care) and Part B (outpatient care such as doctor’s appointments). In addition, you’re eligible for Medigap or Supplemental coverage (including Part D prescription drug coverage) to drive your out-of-pocket expenses down.
Some other attributes of Original Medicare include:
Medicare Advantage: Medicare Advantage or Medicare Part C bundles Part A, Part B, and a combination of other features (depending on which plan you select) like prescription, dental, vision, hearing, and fitness memberships. This means you aren’t eligible for Medigap Supplemental plans as it’s built into your coverage.
Some other Medicare Advantage Plan features include:
The most common Plan C coverage options are:
| Medicare Advantage Plan Choices | |||
|---|---|---|---|
| Features | Health Maintenance Organization (HMO) | Preferred Provider Organization (PPO) | Special Needs Plans (SNPs) |
| Overview | Low cost. | Greater selection to doctors that aren’t in your network. | You’re eligible for SNP if you have a qualifying health condition like diabetes, you have Medicare and Medicaid or live in an in-network assisted living community/home. |
| Primary doctor oversees your care and refers you to specialists. | See specialists without a doctor’s referral. | ||
| Limited to in-network doctors. | |||
| Out-of-Pocket Expenses | Care is provided by in-network doctors, hospitals and clinicians, unless it’s an emergency. | Offers preferred in-network care and gives enrollees discounts for using them. | You will have a primary doctor to oversee your care. Most SNPs rely on in-network care. |
| Seeing non-essential out-of-network doctors costs more. | Higher overall costs. | Some SNPs have $0 copays, premiums and deductibles. They also offer additional funds for over-the-counter health items. | |
| Doctors | Care is provided by in-network doctors, hospitals and clinicians, unless it’s an emergency. | Offers preferred in-network care and gives enrollees discounts for using them. | You will have a primary doctor to oversee your care. Most SNPs rely on in-network care. |
| A referral is required to see a specialist. | Out-of-network care is permitted at a higher copay. | SNPs are for individuals living with certain health conditions or are deemed low income. | |
| No referral to see a specialist is necessary. | Referrals are required to see specialists. | ||
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Like standard Medicare, not everyone is eligible for Medicare Part C. It’s a plan designed for older individuals and disabled individuals.
Here are the criteria for Medicare Advantage plan eligibility:
To apply for Medicare Part C, you must also already be enrolled in Medicare Part A and B and be living in the service area of the Medicare Part C provider you are applying to be covered by.
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The best way to get a handle on whether this plan is right for you is to get a Medicare Part C quote. Contact us. We’ve partnered with the top providers of Medicare Part C coverage and will get you the best coverage at the best price.
The Medicare Advantage Enrollment period runs every year from January 1st to March 31st.
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The main drawbacks of Medicare Part C center around its limitations in terms of providers. To get the lowest cost, you need to use providers in the plan’s network and service area. This may be too limiting to some people.
Coverage can also vary from plan to plan, meaning you could be paying more out-of-pocket costs if you don’t get the best provider for you.
Your Medicare Part C provider may also have company-specific rules about whether or not you need a referral to see a specialist.
However, all Medicare Part C pays a fixed amount for your care every month to the insurance provider you have selected, and these companies must adhere to the rules established by Medicare so you can rest assured you are getting solid coverage.
If you meet the Medicare eligibility requirements and are looking for single-policy, comprehensive coverage, then Medicare Part C is definitely worth considering. It offers you a full-spread of health insurance coverage, at an affordable rate.
Claire Smith Claire is a creative entrepreneur with a variety of marketing and content creation skills, including blog and web copy writing, research, and strategy. She has a Masters in Cultural Studies from Queen's University and is known for thinking laterally about marketing, based on her deep knowledge of people and behavior.
