Medicare Part C — Medicare Advantage Plans


Overview of Medicare Part C

Medicare Advantage, or Medicare Part C, is a program that offers other health plan options that pay for original Medicare-covered services (Parts A and B) plus additional benefits and services through private health insurers such as:

  • Health maintenance organizations (HMOs)
  • Preferred provider organizations (PPOs)
  • Private fee for service (PFFS) plans
  • Special needs plans (SNPs)

How Medicare Advantage Plans Work

  • The funds paid by the federal government to these private health insurers are used to pay the doctors, specialists and hospitals that you use; however, the care is managed by the private health insurers.
  • The private health insurers may also offer supplemental benefits not covered by original Medicare such as vision, hearing, chiropractic care and more.
  • Plan members usually are directed toward a network of doctors, hospitals and other health care professionals to receive services, but are not required to use those professionals.

Medicare Advantage Plans — Costs

  • In a Medicare Advantage plan, you may pay a monthly premium as well as copayments - which are usually a fixed amount - when you receive services.
  • The Medicare Advantage premium includes coverage for Medicare Part A and Medicare Part B benefits, prescription drug coverage (if offered) and any other benefits allowed by the plan.
  • You will also continue to pay your Medicare Part B premium while enrolled in Medicare Advantage.

Medicare Advantage Plans — Drug Coverage

  • Health insurers offering Medicare Advantage plans generally must provide at least one plan with basic prescription drug coverage, but most offer multiple options.
  • If you choose a Medicare Advantage plan that offers prescription drug coverage, you must receive your benefits through that plan, rather than enrolling in a separate Medicare Part D plan.

Medicare Advantage Eligibility

  • You are eligible for Medicare Advantage if you are entitled to Medicare Part A and enrolled in Medicare Part B.
  • If you choose a Medicare Part C plan, your coverage becomes effective the same date as your Medicare coverage.

Medicare Part C Enrollment

Initial Enrollment Period

  • This is a seven month enrollment period for those who are newly eligible for Medicare as a result of turning 65.
  • The seven month period consists of the three months before, the month of and the three months after your 65th birthday.
  • If you choose not to enroll during your initial enrollment period, you may be subject to a late enrollment penalty

Annual Enrollment Period

  • Between October 15 and December 7 of each year, anyone eligible for Medicare Advantage coverage may either switch plans or enroll in a plan.

Special Enrollment Period

  • There are several special circumstances that would allow a Medicare-eligible recipient to enroll in a Medicare Advantage plan outside of the initial or annual enrollment periods.
  • Some examples include, but are not limited to:
    • Moving into the service area
    • Involuntarily losing creditable coverage
    • Becoming dual eligible (qualified to receive more than one state or federal subsidy)

*When you enroll in a Medicare Advantage Plan you cannot also have Medicare Supplement Insurance.