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Understanding Medicare Part C and Part D

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Medicare Part C, Medicare Part D… What do they mean? We’ll go over these parts of Medicare.

What’s Medicare Part D?

Medicare Part D is the Medicare prescription drug coverage program. Medicare Part D is optional coverage and you can get it from private, Medicare-approved insurance companies in a couple of different ways.

  • If you’re enrolled in Original Medicare, Part A and/or Part B, you can sign up for a stand-alone Medicare Part D prescription drug plan.
  • If you’d rather enroll in a Medicare Advantage plan (described below), chances are you can get Medicare Part D coverage through your Medicare Advantage plan.

What’s Medicare Part C?

Medicare Part C is the Medicare Advantage program. Part C gives you an alternative way to get your Original Medicare (Part A and Part B) benefits.

So, you could say that Part C = Part A + Part B.

Medicare Advantage plans are available through private, Medicare-approved health insurance companies. It’s common for Medicare Advantage plans to include prescription drug coverage through Medicare Part D. These are sometimes called Medicare Advantage Prescription Drug plans.

When it comes to Medicare Advantage Prescription Drug plans, you could say that Part C = Part A + Part B + Part D.

Under Medicare Part C, Medicare Advantage plans can also offer extra benefits, like routine dental services or membership in fitness programs.

What else should I know about Medicare Part D?

Either way you decide to get Medicare Part D coverage, there are a few things to keep in mind:

  • Not every plan will cover every prescription drug. If you’re on medications, you might want to make sure your Medicare prescription drug plan covers them. Each plan has its own formulary – that’s a list of prescription drugs the plan covers.
  • Even if you find a plan that covers your prescriptions, know that a plan may change its formulary anytime. Your plan will notify you when necessary.
  • Every fall, your plan will send you Annual Notice of Change and Evidence of Coverage documents. Check to see how your coverage may be changing next year, including if any of your medications will be dropped from the formulary, or if your costs are going up.
  • You don’t have to sign up for prescription drug coverage under Medicare Part D. But if you decide to sign up after your Medicare Initial Enrollment Period, you could face a Part D late enrollment penalty.

What else should I know about Medicare Part C?

  • Even though you get Medicare Advantage plans through private insurance companies, you’re still in the Medicare program through Medicare Part C.
  • You still need to keep paying your Medicare Part B premium, along with any premium the plan may charge.
  • You have to have Medicare Part A and Part B to qualify for benefits under Medicare Part C. You also have to live within the plan’s service area.
  • There’s one benefit you still get directly through Medicare Part A, instead of through the Medicare Advantage plan: hospice benefits.
  • Some Medicare Advantage plans have provider networks. You might be limited to providers in the plan’s network. In some cases, you can see out-of-network providers, but you might have to pay a higher copayment or coinsurance.
  • Medicare Advantage plans have annual maximum out-of-pocket spending limits. If you pay up to that limit within a calendar year, the plan generally pays for your covered medical expenses for the rest of that year. This spending limit may vary from plan to plan and from year to year.

When can I sign up for Medicare Part C or Part D, or change plans?

  • If you’re new to Medicare, you can enroll in Medicare Part C or Part D during your Initial Enrollment Period.
  • The fall may be a good time to compare plans and see if you’re getting the best possible Medicare health or prescription drug plan for your needs. You can change plans during the Annual Election Period.

Is it time to compare plans to see if there’s any plan in your area that may be better for you? Just click the button on this page to get started with no obligation. You can also contact eHealth to reach our licensed insurance agent.

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