Medicare Part C: Frequently Asked Questions About Medicare Advantage Plans

When you first become eligible to enroll in Medicare, you have the option of deciding how you would like to receive coverage. You can enroll in Original Medicare, which includes hospital insurance (Part A) and medical insurance (Part B). If you want additional coverage for your prescriptions, you can also opt to enroll in a separate Medicare Prescription Drug Plan (Part D).

But if you want a more comprehensive coverage plan that provides additional benefits Original Medicare may not offer, you have another option. In addition to enrolling in Original Medicare, you can sign up for a Medicare Advantage Plan, also known as Medicare Part C.

At Minnesota Benefit Association, our partners understand Medicare coverage options can be confusing, and we’re here to help you navigate the ever-changing health insurance landscape. Read on to learn what you need to know about Medicare Part C, and as always, feel free to contact our team with any questions.

What Is Medicare Part C?

Medicare Part C, also referred to as Medicare Advantage, is an alternative to Original Medicare that combines multiple types of coverage into a singular plan.

Unlike Original Medicare, which is a federally controlled health insurance program, Medicare Advantage plans are a form of private health coverage offered by Medicare-approved insurers.

There are several types of Part C plans that Medicare beneficiaries can choose from, including:

  • Health Maintenance Organization (HMO) plans
  • Preferred Provider Organizations (PPO) plans
  • Private Fee for Service (PFFS) plans
  • Special Needs plans (SNPs)
  • Medicare Medical Savings Account (MSA) plans
  • HMO Point of Service (HMOPOS) plans

What Does Medicare Part C Cover?

Medicare Advantage plans combine Medicare Part A (hospital insurance) and Part B (medical insurance). Many of these plans also provide Medicare Part D (prescription drug coverage), as well as additional benefits, such as vision, dental, hearing, and wellness coverage.

Though most MA plans include Part D coverage, some of them — like Medical Savings Account plans — cannot offer it. Others, including certain Private Fee-for-Service plans, elect not to offer Part D coverage. However, if you have one of these plans and need Part D coverage, you can still join a separate prescription drug plan.

More recently, the Centers for Medicare and Medicaid Services has also permitted Part C to provide coverage for extras, including but not limited to:

  • Transportation to and from doctors’ appointments
  • Meal delivery to the home
  • Other necessary household implements, including shower grips and wheelchair ramps

It’s important to note that not all Medicare Advantage plans provide coverage for the same extra benefits. And, MA plans can elect not to cover services that are not considered medically necessary under Medicare. As such, it’s always best to consult with a licensed advisor to ensure you sign up for a Part C plan that provides the benefits you need.

Who Is Eligible for Medicare Part C?

If you decide you’d like to enroll in a Medicare Advantage plan, you must enroll in Medicare Part A and Part B, and pay your monthly Part B premium.

In addition to signing up for Original Medicare, you’ll also need to select a Part C plan and sign up through a private insurer. Keep in mind that you must live within the plan’s service area, which is based on your county of residence, not your state.

If you’ve been diagnosed with End-Stage Renal Disease (ESRD), you are only eligible for coverage under an MA plan in the following situations:

  • You already had coverage under an MA plan when you developed ESRD.
  • You are already receiving health benefits through an organization that offers Part C plans.
  • You had a successful kidney transplant and still qualify for Medicare benefits.
  • There is a Medicare Special Needs plan for people with ESRD available in your area.

If you have ESRD, you may also qualify for a Special Enrollment Period, during which you have a one-time right to join another plan.

When Should You Enroll In Medicare Part C?

If the MA plan you select is accepting new members, you may enroll in or change your Part C coverage during the following periods:

  • Your Initial Enrollment Period, which is the 7-month period beginning 3 months before you turn 65 and extending 3 months after your 65th birthday
  • The Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, which occurs from October 15 to December 7 each year
  • The Medicare General Enrollment Period, which occurs from January 1 to March 31 each year
  • Special Enrollment Period, which may apply to you under certain circumstances

How Much Does Medicare Part C Cost?

The amount you must pay for an MA plan depends on a variety of factors, including:

  • Whether your plan pays a portion of your Part B premium
  • Whether the plan requires you to pay a monthly premium (some plans are premium free)
  • What you pay for copayments and coinsurance
  • Whether your plan has any deductibles
  • Whether you need extra benefits
  • The type of health care services you require and the frequency at which you get them
  • Whether you adhere to the plan’s rules
  • Whether you have Medicaid or get state-sponsored help
  • The plan’s yearly limit on out-of-pocket expenses

With Medicare Advantage, premiums and deductible amounts are determined annually by the plan, as are service charges. As such, what you pay for your plan may only change once per year, on January 1.

Need Medicare Enrollment Assistance? Contact the MBA

When you have questions, our licensed advisors have answers, so give us a call at 651.358.2990