What Is a Medicare Advantage (Part C) Plan?

Medicare is a health insurance program run by the federal government that covers people aged 65 and older, people with certain disabilities, and younger people with long-term healthcare needs. It was enacted in 1965 and is funded by payroll taxes and general revenue. The program has several parts. Part A covers hospital costs, Part B covers outpatient care and some other services, Part C is Medicare Advantage, and Part D is private insurance to cover prescription drugs.

The federal government sets essential criteria for eligibility for each part. It also determines the services to be covered for each. The services are covered either partially or wholly. People who qualify for Medicare but do not buy parts can still get traditional Medicare, which covers hospital stays, physician visits and other inpatient treatment, and some home healthcare services. Part C is a new way of providing insurance to people who are on Medicare. It allows them to choose private health insurance companies that provide all or part of their health care coverage.

What Is the Medicare Advantage (Part C) Plan Like?

This is an optional health insurance plan operated by Medicare-approved private health insurers. It provides coverage for services not covered by Part A or Part B. It is a hybrid plan with the private insurer working with the federal government to provide some services and the federal government providing other services. The plan usually provides substantial benefits beyond what Medicare pays for either side, such as co-payments, deductibles, and premiums for medicines and physician visits.

Medicare Advantage started in 1996 as a pilot program and was made permanent in 2003. This plan was designed to allow people who qualify for Medicare to obtain health insurance coverage that supplements the basic types of care provided by traditional Medicare but does not replace it or provide all the benefits. The government subsidizes these plans' premiums and provides other financial incentives.

How to Enroll in a Medicare Advantage (Part C) Plan

You can enroll in the Medicare Advantage (Part C) plan anytime during the annual open enrollment period in October and November. The plans offer different types of coverage, including HMOs, PPOs and Point of Service (POS) plans. The coverage provided varies depending on which company provides the plan. Choosing a plan can be challenging because many plans have similar premiums and deductibles.

Your doctor will provide a list of plans they have contracted with, and you can select a plan from the list. If you have a plan and are happy with the service, you don't need to re-enroll each year. Your coverage will stay in effect until your current plan expires and you choose to renew it or revise your choices. If you are unhappy with your current plan, you can change it during the annual open enrollment period. If you do not re-enroll when your current plan expires, you will automatically be enrolled in the Standard Medicare Plan.

You can sign up for a plan as an individual or a family. From time to time, some Medicare Advantage plans have a special enrollment period that allows certain people to change their plans without any or with limited waiting periods.

What Does Medicare Advantage (Part C) Cover?

There are several plans with various levels of coverage. Your needs will determine the type of plan that is best for you. Some basic benefits provided in every plan are doctor visits and lab tests. Other services covered include basic hospice care, immunizations, and preventive care services such as diabetes, blood pressure and cholesterol screenings, flu shots, colonoscopies, and mammograms. Medicare Advantage plans also provide services not covered in traditional Medicare. These include physical therapy, chiropractic care, psychotherapy, acupuncture, podiatry, and optometry.

Your plan may also cover in-home care, transportation, hearing aids, and other medical devices. It should pay for many prescription drugs including antibiotics, blood pressure medications, and antidepressants. However, there are some restrictions on the coverage of some medications. These include certain blood pressure medicines and certain cancer medications.

How Much Does Medicare Advantage (Part C) Cost?

The annual cost of Medicare Advantage coverage is based on the type of plan you select and your health status. This is called a benchmark premium. The benchmark premium is not fixed, but rather fluctuates yearly after changes are made using the CMS actuarial market basket. The formula for the benchmark premium is based on the current average premium charge for each plan in your area and the estimated expected costs for services under that plan. The goal is to keep this cost level stable over time.

The rates are updated annually by multiple factors, including the fee schedule for specific services, hospital costs, and other enrollees' longevity. This allows Medicare Advantage plans to charge you a more than reasonable price and stay within their budgeted expenses.

To understand the process, you need to know that not all Medicare Advantage plans are identical. Each plan may have a unique fee schedule. The exact cost will be determined by the benefits you choose and the rates negotiated by the insurance company with the providers they contract. Purchasing a Medicare Advantage (Part C) plan is similar to buying any health insurance product.

Benefits Provided by a Medicare Advantage (Part C) Plan

Medicare Advantage plans have special features such as free visits to specialists and other medical professionals, a prescription drug plan, no premium for preventive care services, and assistance paying for Medicare premiums. You can get care from any provider if they accept your Medicare Advantage plan's network. This can include doctors, hospitals, and pharmacies. Choose a plan that provides the benefits and services you need to get the best value.

If you have Medicare, consider purchasing a Medicare Advantage (Part C) plan. Do extensive research before committing. A medical professional can help you choose the best plan for your unique needs.