Medicare, Part C...Explained

Medicare Part C or Medicare Advantage is one of the four Medicare parts: A, B, C, and D. Part C offers Medicare beneficiaries a different way to get Medicare benefits through plans sold by private insurance companies that hold contracts with the Centers for Medicare & Medicaid Services.  Medicare Part C pays instead of Medicare. Medicare Part C is not a Social Security program that you enroll in.

The best way to think of Medicare Advantage plans is this. Package that have Part A, Part B and usually Part D rolled into one plan. There is one ID card to use at the doctor’s office, hospital, and pharmacy. Advantage plans may include a built-in Part D drug plan, although in some areas they are without Part D.

Medicare C plans are like group insurance benefits given through employers. Most of the time there will be a local network of providers to choose from. There will be copays for many routine services like doctor’s visits, lab-work, ambulance, surgeries, hospital stays, urgent care and more.

How Medicare Part C Works

All Medicare beneficiaries, regardless of age, can purchase a plan if they meet the following criteria:

  • They reside in the plan’s service area. Medicare Part C qualification will be based on the address that they have on file with Social Security. They select a plan that works in that same county. Some plans may be specific to only one or two counties while others might span the whole state.

  • They are enrolled in both Medicare Part A and B. Many people are under the impression they can get rid of Part B if they enroll in a Medicare Part C plan. This is false. If they drop Part B, they will immediately lose their Part C plan.

  • Lastly, they must not have End-Stage Renal Disease. This is the only medical question on a Part C application.

It's important to remember that Medicare Advantage plans have election periods. This means that applicants can enroll during your Initial Enrollment Period or during the Annual Election Period in the fall. There are also specific Special Election Periods (SEPs) in certain circumstances, such as if they move out of state and lose their plan. The applicant would then be granted a SEP to enroll in a plan mid-year in their new state.

What Medicare Part C Covers

Medicare Part C will cover all the same services as Part A and B that are offered by Medicare. It will cover both hospital and outpatient benefits, but instead of paying deductibles and 20% of medical services, plan holders pay the plan’s copays.

Each Medicare Advantage plan has a summary of benefits.  In this summary, it will list out various medical services. The summary will show what the copay or coinsurance will be for each service. For example, it may cost $10 for lab work, $50 for a specialist visit, $200 for an MRI–and so on.

If you are thinking of becoming a life and health agent, it essential that you can explain these coverages to your clients. If you are looking for help to understand these plans and an online insurance school to equip you with the tools to pass your insurance exam and counsel your clients, look no further.

This is part 7 of a multi-post series.  Please visit the other Insurance Career posts below:

Medicare, Medigap & Medicaid

Medicare Supplements (Medigap)...Coming Soon

Medicaid...Coming Soon

Medicare Part A

Medicare Part B

Medicare Part C...Now Playing

Medicare Part D

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