Medicare Part C: Medicare Advantage Plans

You can get the benefits of Medicare Part A and Medicare Part B together through one plan managed by a private insurance company, like Medical Mutual. This is known as Medicare Part C or Medicare Advantage. Insurance companies that offer these plans contract with the federal government to administer the same services offered in Medicare Part A and Medicare Part B, but often offer additional benefits, like prescription drug coverage and wellness benefits. Medicare Part C plans may require a monthly premium. Enrollees are still required to continue paying the Original Medicare Part B premium.

Part C Eligibility

If you are eligible for Medicare Parts A and B, you are eligible for Medicare Part C. You must also live in the plan’s service area. If you have other coverage through your employer or union, check with your benefit administrator to make sure you won’t lose it by enrolling in a Medicare Part C plan.

The Advantages of Medicare Part C

Everything that’s covered in Medicare Part A and Medicare Part B is also covered in a Medicare Part C plan. The difference is that a Medicare Part C plan may offer more, like routine vision and dental care, wellness programs and prescriptions drug coverage. Your copayments and deductible could also be lower, depending on your plan. There are six types of Medicare Part C plans:

  • HMO (Health Maintenance Organization) Plan – Provides coverage in a specific network of doctors and hospitals. The network is usually smaller than a PPO plan, but you typically have lower out-of-pocket costs.
  • PPO (Preferred Provider Organization) Plan – Gives you the flexibility to choose from a larger network of doctors and hospitals.
  • HMO POS (Health Maintenance Organization-Point of Service) Plan – Offers coverage for out-of-network providers but at a higher out-of-pocket cost than in-network providers.
  • PFFS (Private Fee-for-Service) Plan – Pays doctors set fees for services that must be accepted (even if they are lower than the usual charge) before treatment is approved.
  • SNP (Special Needs Plan) – Provides coverage with prescription drug benefits that help people with the following special needs:
    • Those living in institutions
    • Those who are dual-eligible for Medicaid and Medicare
    • Those living with chronic conditions, including diabetes, end-stage renal disease (ESRD) or HIV/AIDS
  • MSA (Medical Savings Account) Plan – Consists of a high-deductible plan plus a bank account that uses tax-free funds to help pay your deductible and other IRS-qualified medical expenses.

Medicare Part C Enrollment

You have up to three opportunities during the year to enroll in Medicare Part C. They include the Initial Election Period, the Annual Election Period and the Special Election Period.

Initial Coverage Election Period

You can enroll in a Medicare Part C plan when you first become eligible for Medicare (three months before you turn 65). This is the start of your Initial Coverage Election Period, which lasts seven months and includes:

  • Three months before your 65th birthday
  • The month you turn 65
  • The three months after your birthday

If you start receiving Social Security disability benefits before you turn 65, you can sign up for a Medicare Part C plan after 21 months and will have eight months to enroll.

Annual Election Period

If you decide to enroll in a Medicare Part C plan after you’re already enrolled in Original Medicare Parts A and B, and your Initial Election Period has passed, you must wait until the Annual Election Period. This period begins on Oct. 15 and ends on Dec. 7. Your plan begins on Jan. 1 of the following year.

Once you enroll in a Medicare Part C plan, you usually can’t make changes until the next Annual Election Period.

Special Election Period

There are some situations where you can change your plan or enroll in a new plan outside of the Annual Election Period, including:

  • Moving somewhere outside of your plan’s coverage area
  • Qualifying for Extra Help (a program that helps pay for prescription drugs)
  • Moving into a nursing home or other institution