Medicare Part C plans, also known as Medicare Advantage plans or “Managed Medicares”, function much like traditional HMOs or PPOs. When someone joins one of these plans, Medicare pays a fixed amount each month to a private third-party company that provides the plan, and that company is in turn responsible for providing the enrollee’s care.
Part C plans must follow rules set forth by Medicare; however, each plan may have different out-of-pocket costs such as yearly deductibles and co-pays, as well as different rules regarding accessing services. Limitations on services may include requiring a referral to see a specialist as well as in-network and preferred doctors, facilities, or suppliers for non-emergency or non-urgent care. Most plans include Medicare prescription drug coverage (Part D). Some plans charge a monthly premium in addition to the standard Part B premium.
Some Medicare Advantage plans offer perks such as free gym membership as a way to attract new members. When choosing a plan, be careful not to choose a plan for these perks at the expense of more critical healthcare coverage. Make sure that your doctors are in the plan’s network and try to find out what other people’s experiences have been with the plan.
Many Part C plans include Part D – prescription drug coverage.
Having Original Medicare Parts A and B with a Medigap (supplemental) policy will often provide more options than a Medicare Part C plan when it comes to seeing doctors and receiving other services. This is primarily because those enrolled in Original Medicare are not restricted to a third-party provider network. Their health insurance is simply Medicare (which is provided by the Federal government). They can go to any doctor or hospital, or receive any service, test, or durable medical equipment, as long the provider accepts Medicare.
Enrollment for Part C
When initially enrolling in Medicare you are given the opportunity to enroll in a Medicare Advantage (Part C) and/or Part D plan. Subsequently, every year you have the opportunity to make changes in your Medicare between October 15 and December 7. This period is called “Open Enrollment”. Additionally, between January 1 and February 14 you can disenroll from a Medicare Advantage plan and switch to Original Medicare. If you choose to do this, you have until February 14 to enroll in a Part D (prescription drug) plan.