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What is Medicare Part C

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Medicare Part C, also called Medicare Advantage, is a way to get your Medicare benefits from a private insurance company approved by Medicare. Medicare Part C plans cover everything that Original Medicare (Part A and Part B) cover and many Medicare Part C plans offer additional benefits. When you have Medicare Part C you are still part of the Medicare program and still have the same privileges and rights.

What are the extra benefits of Medicare Part C?

Medicare Part C plans often cover benefits that Original Medicare doesn’t generally cover. One of the most notable of these benefits is prescription drug coverage since Original Medicare doesn’t cover most prescription drugs you take at home. Other extra benefits of Medicare Part C plans may include:

  • Routine dental coverage
  • Routine hearing coverage (including hearing aids)
  • Routine vision coverage (including eyeglasses)
  • Fitness benefits

What are the costs of Medicare Part C?

The out of pocket costs of Medicare Part C may be lower than the costs of Original Medicare. Like Original Medicare, Medicare Part C plans may come with monthly premiums, as well as copayments/coinsurance, and deductibles. The amount of these costs may vary from plan to plan. Some Medicare Part C plans have premiums as low as $0 as well as $0 deductibles. You still must pay your Medicare Part B premium. Unlike Original Medicare, Medicare Part C plans all have out-of-pocket maximums. This means that you only have to spend a pre-determined amount out of pocket before all your covered medical expenses are paid for.

Medicare Supplement plans help pay Medicare out of pocket costs, including copayments, coinsurance and deductibles. However, you cannot use a Medicare Supplement plan together with a Medicare Advantage plan.

Who can enroll in Medicare Part C?

To enroll in Medicare Part C, you generally must be enrolled in Medicare Part A and Part B. You also must live in the plan’s service area. If you have end-stage renal disease, you may be excluded from some Medicare Part C plans. However, you may be able to enroll in a Medicare Part C special needs plan for people with ESRD.

When can I enroll in Medicare Part C?

Your first opportunity to enroll in Medicare Part C may be your Initial Enrollment Period. This is a 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you sign up for a Medicare Advantage Plan during this time, you can drop that plan at any time during the next 12 months and go back to Original Medicare.

If you don’t enroll during your Initial Enrollment Period, you may be able to enroll during the Annual Election Period which lasts from October 15 through December 7 of each year.

How else is Medicare Part C different from Original Medicare?

Many Medicare Part C plans have networks of participating providers. If you go out of network to visit a doctor, you may pay more out-of-pocket and your copayment/coinsurance may not count towards your out of pocket maximum. Types of Medicare Part C plans include:

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

Many Medicare beneficiaries opt for a Medicare Part C plan. To see if this option may be a good idea for you, contact eHealth’s licensed insurance agents. We have the knowledge to answer your Medicare Part C plan questions.

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