A quick guide to Medicare Part C

Medicare Advantage Plans (like HMOs and PPOs) are sometimes referred to as Medicare Part C. They are private Medicare-approved health plans for those individuals eligible for Medicare. When you join a Medicare Advantage Plan, you are still in Medicare.

Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage and must cover medically necessary services. They generally offer additional benefits, and many include Part D prescription drug coverage. These plans often have networks, which means you may have to see the plan’s doctors and go to certain hospitals to get care.

Medicare Advantage Plans can save you money, since out-of-pocket costs in these plans are generally lower than with Original Medicare alone. However, your cost will vary by the services you use and the type of policy you purchase. Each Medicare Advantage Plan can charge different out of pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan).

Plan options can include:

  • Preferred Provider Organization (PPO)
  • Health Maintenance Organization (HMO)
  • Private Fee-For-Service (PFFS)
  • Special Needs Plans (SNP)
  • Medical Savings Account (MSA)

You can generally join if:

  • You live in the service area of the plan you want to join
  • You have Medicare Part A and Part B coverage
  • You don’t have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)  This is no longer true for plans effective after January 2021.

Choose your plan carefully, as usually you will only be able to change plans once a year.

Individuals with a Medicare Advantage plan may elect to dis-enroll from their MA plan during the Medicare Advantage Disenrollment Period from January 1 through February 14 in order to return to Original Medicare. These individuals may enroll in a Part D plan during this time frame only.

Still have questions, or need more information on how to pick the plan that is right for you?