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Overview of Medicare Part C

Medicare Part C is also called Medicare Advantage Plan.  Medicare Part C combines the benefits of Part A, Part B, and Part D into a single managed care plan that covers all medically needed services.  The difference is that Medicare Part C coverage is provided by private insurance companies that are approved by Medicare.  The benefit of Medicare Part C is that it is a lower-cost alternative to the Original Medicare Plan, and providers usually offer extra benefits and include prescription drug coverage (Part D) so that people with Part C coverage need not buy Part D drug coverage.

Medicare Part C plans often have networks, and so the beneficiary must use the doctors or hospitals that belong to the plan.  The benefit of Part C is that it includes specialized care for people who need a large amount of health care services and moreover, Part C also covers a beneficiary who needs emergency or urgent care and medical attention while traveling out of the plan coverage area.

A person who joins Medicare Part C will have complete Part A and B coverage.  The person will also continue to have Medicare rights and protection and in most cases.

A person who wishes to join Medicare Part C has several plans to choose from.  The plans include:

  1. Medicare Preferred Provider Organization (PPO) – A person having this plan will be able to see any doctor or specialist of his/her choice.  However, if the doctor/specialist is not in the person’s PPO network, the cost will increase.  The benefit is that a person can usually see a specialist without a referral.
  2. Medicare Health Maintenance Organizations (HMO) – A person having this plan will be able to visit doctors in the HMO network only.  In most cases, the person will also be required to have a referral to visit a specialist.
  3. Medicare Private Fee-for-Service (PFFS) – A person having this plan will be able to see any doctor or specialist, if they are willing to accept the PFFS’s fees, terms, and conditions.  The person also does not need to have a referral to see a specialist.
  4. Medicare Special Needs – These plans are designed for people with certain chronic diseases or other special health needs.  These plans include Part A, Part B, and Part D coverage.
  5. Medicare Medical Savings Account (MSA) – There are two parts to this plan:
  • A high-deductible plan where coverage will not begin until the annual deductible is met.
  • A savings account plan where Medicare deposits money for the beneficiary to use for health care costs.

The most important aspect of Medicare Part C is that out-of-pocket costs are generally lower than in the original Medicare plan.  Moreover, a person who has joined the Medicare Part C program generally does not need to buy a supplemental insurance policy.

Enrolling in Part C policy however requires comparison shopping because Part C coverage is provided by private insurers.  Therefore, it is important to choose a plan after considering the actual coverage being offered and after a comparison of the plans of different providers.

Inside Overview of Medicare Part C