Medicare Part C is also known as the Medicare Advantage Plan. The types of plans that are basically included are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Other plans that are included under Part C are Medical Savings Accounts (MSAs), Private Fee-for-Service (PFFS) and Medicare Special Needs Plans (MSNP). These plans are provided by private insurance companies that are preapproved by Medicare. Medicare Part C is not supplemental insurance. Every plan under Part C is different, so it is important to find out a plan's policies before enrolling.
Eligibility
To receive Medicare Part C, a beneficiary must already have Parts A and B. Beneficiaries must also live in an area that their plan of interest provides coverage to. A beneficiary can receive Medicare Part C if they have been diagnosed with a pre-existing condition. The only pre-existing condition that is not accepted is End-Stage Renal Disease (ESRD), which is permanent kidney failure. Beneficiaries with ESRD may be eligible to enroll in an MSNP.
Coverage
Medicare Part C gives beneficiaries coverage for both Parts A and B, which are hospital and medical insurance, respectively. An advantage of having Medicare Part C is that the plans provide additional coverage for certain services, such as wellness programs, hearing and vision checkups and dental. A majority of the Part C plans also provide prescription drug coverage (Part D). Some plans under Part C have networks of providers that beneficiaries under the plan are only allowed to see. This is in exception to medical emergencies. If a beneficiary were to see a provider who is not a part of the network, his services may not be paid for by his plan. Also, if a beneficiary needs to see a specialist, he must also get a referral from his plan.
Costs
Medicare Part C plans charge beneficiaries a monthly premium, which is a combination of the premiums for their Parts A, B and D coverage, and any additional coverage that may be offered. Some plans will pay the beneficiary's Part B premium each month. Depending on the plan, it may or may not charge for a yearly deductible. Furthermore, a beneficiary may be required to pay different co-payments. This, too, depends on which plan the beneficiary is enrolled in.
When to Enroll
Medicare beneficiaries will be able to enroll in Part C only during certain time frames. The first is when the beneficiary first becomes eligible for Medicare. This is three months before the beneficiary turns the age of 65. Another time frame in which a beneficiary can join is during the three months before and after receiving her 25th Social Security disability payment. Medicare Part C is also available during open enrollment between November 15 and December 31 of every year. If a beneficiary signs up during this time, January 1 of the following year will be her coverage start date. Beneficiaries are also allowed to enroll between January 1 and March 31 of every year.
Enroll
After choosing a Medicare Part C plan, beneficiaries have three ways to enroll. This can be done by just completing the paper application, by calling the plan's customer service to enroll or by simply enrolling online. When enrolling, the beneficiary will be asked to provide his Medicare number and the dates that his Parts A and B coverage began. After the enrollment has been processed and approved, the beneficiary will receive all membership information and materials in the mail.
Tags: Medicare Part, under Part, additional coverage, beneficiary will, every year