A non-government website

To speak to a Licensed Insurance Agent

(TTY 711)

Mon - Fri, 9 AM - 6 PM EST

How to Get Enrollment in Medicare Part C

Medicare Part C

There’s a strong possibility you’ll have to sign up for Medicare after you turn 65. You can postpone getting coverage for a while—until you or your spouse loses your job, for example—but eventually, you’ll do it. Two primary choices are available: Original Medicare, Parts A and B (hospital and medical coverage, respectively), and Medicare Advantage, generally known as Medicare Part C.

Speaking on behalf of the National Patient Advocate Foundation, Caitlin Donovan explains that Medicare Advantage is a commercial Medicare plan.

She advises imagining it as a cross between Medicare and private insurance. Private insurance firms manage Medicare Advantage plans but must stick to the same rules and guidelines that apply to Medicare. She claims that the government has a greater say in what Medicare Advantage must cover than other types of insurance.

The plans do differ in a few significant ways, though. You can learn everything there is to know about Medicare Part C in this article, including whether it is a good fit for you.

It doesn’t have to be difficult to choose the Medicare plan that fits your needs and budget; eHealth is here to assist. Start right now.

How do Part C Medicare plans operate?

The same coverage that Original Medicare provides, including Part A (hospital insurance) and Part B, is also provided by Medicare Advantage plans (medical insurance). This implies that your hospital expenses, doctor visits, and other medical services will be covered under Medicare Advantage in the same way that they would be under Original Medicare.

However, there are distinctions between how Original Medicare and Medicare Advantage cover certain services.

Seeing a doctor

Earliest Medicare: Medicare is accepted at any medical facility in the United States, and appointments with specialists typically don’t require a reference.

Advantageous Medicare: For non-emergency treatment, you normally have to go to in-network clinics and hospitals and obtain a referral before seeing a specialist.

Original Medicare fees: After you reach your deductible, you’ll typically pay a 20% coinsurance for any care you receive (the amount you pay before your insurance starts kicking in). However, there is no cap on the amount you can pay out of pocket.

Medicare Advantage: Depending on the service, these out-of-pocket costs may change. However, there will be a yearly cap on how much you must pay, unlike Original Medicare.

Advantages of Original Medicare: No dental, vision, hearing, or pharmaceutical coverage (except those you might receive during a hospital stay). For coverage, you must purchase individual supplemental plans.

Medicare Advantage: Part C plans frequently bundle these advantages with extras like gym memberships or price breaks. According to Donovan, the majority of them also cover prescription drugs, so you might not need to acquire separate coverage for prescription drugs (Medicare Part D).

Find a Medicare Advantage plan that is inexpensive and offers extra benefits. We can assist you in finding a Medicare Advantage plan that covers everything, including potentially free dental coverage, hearing aids, eyeglasses, and more.

What different Medicare Advantage plan kinds are there?

Medicare Advantage plans vary widely. While some require you to select a primary care physician or get a referral from a specialist, some offer a wider coverage network. Some of the most prevalent MA plan types are listed below.

Plan from a health maintenance organization (HMO). In an HMO, you often have to visit hospitals and doctors who are part of the network. These programs generally cover prescription medicines. One thing to remember is that choosing a primary care physician and getting a referral to see a specialist are likely requirements.

  • Medical Savings Account (MSA) plans: You can often receive medical treatment from any doctor or hospital with an MSA plan. You must enroll in a different Medicare prescription drug plan, as these policies don’t cover prescription medications. Similar to health savings accounts not affiliated with Medicare.
  • A Preferred Provider Organization (PPO) plan allows you to network hospitals, physicians, specialists, and out-of-network providers for some services, though typically at a greater cost. PPOs usually cover prescription medicines.
  • Private Fee-for-Service (PFFS) plans: These allow you to visit any physician, healthcare facility, or hospital that accepts the payment terms of your plan. There is a network of providers available for some PPFS plans. Out-of-network doctors could cost extra. Only a few PPFS cover prescription drugs.
  • Special Needs Plan (SNP): SNPs are made specifically for those with certain diseases or medical needs and those with restricted financial resources. Out-of-network services may be covered by some plans but not by others. They all offer drug coverage. Require a primary care physician and a specialist referral.

What is the cost of Medicare Part C?

Different plans may have different premiums, deductibles, and copayments for Medicare Part C.

With Medicare Advantage, you can be required to pay both the monthly premium for the plan and the Part B premium that all beneficiaries of Original Medicare are required to pay. (The monthly premium in 2022 was $170.10) A “Medicare Part B premium reduction” is a term used to describe other Medicare Advantage plans that charge no premium and assist you in paying the Part B premium.

Medicare Advantage plans, unlike Original Medicare, also feature out-of-pocket maximums, which means that if your deductible is met, you won’t have to continue paying for your medical expenses. For in-network services, the out-of-pocket maximum for 2022 can be, at most, $7,550. Some people purchase a Medicare supplement plan, commonly known as Medigap, which helps fill in the gaps in your current coverage because Original Medicare has no cap on the out-of-pocket expenses you could have to pay.

But keep in mind that if you are a beneficiary of a Medicare Advantage plan, you cannot enroll in a Medigap plan.

Who is eligible to participate in Medicare Part C?

Keep in mind that you will probably need to decide on the major subject of your paper. If you have Medicare Parts A and B, you might be able to switch from the original Medicare to a Medicare Advantage plan. Even if you already have a medical condition, you are still eligible to enroll.

When is the Medicare Part C enrollment period?

Only at specific times of the year do you have the option of joining a Medicare Advantage plan. The first chance comes up during your Initial Enrollment Period, a seven-month window that begins three months before and ends three months after your 65th birthday.

In addition, it is possible to sign up for a Medicare Advantage plan during the annual Open Enrollment period (OEP), which begins on October 15 and lasts until December 7 each year. This time begins on the 15th of each year. Your coverage will begin on January 1 if you enroll. The following opportunity is available from January 1 through March 31 during the Medicare Advantage Open Enrollment period. After you sign up, coverage starts on the first of the next month.

Some individuals also qualify for a Special Enrollment Period (SEP), during which they may enroll in a Medicare Advantage plan if certain life events, such as a move or a change in employment, apply.

Understanding the Best Medicare Advantage Plans

Choosing the right Medicare Advantage plan can be difficult. Although there are general quality ratings, your specific needs will determine the ideal plan.

You could ask whether your meds are covered and how much they cost. To evaluate the possibilities. Do you need access to additional services to treat a specific condition? Would you rather take a chance on a lower-premium, higher-deductible plan or pay more each month to save money in the future?

Because only you can answer these kinds of questions, only you can decide which strategies are superior to others for you.

To assist you in identifying the common characteristics of the top Medicare Advantage plans overall, MoneyGeek examined national information.

The majority of Medicare Advantage plans are PPO or HMO.

PPO and HMO plans account for 46% and 39% of all Medicare Advantage plans.

Other kinds of plans are accessible.

Private fee-for-service plans compensate providers per service rather than per patient under their care. Since these plans don’t usually have a predetermined network of providers, members can see almost any provider who accepts Medicare. PFFS plans make up just 2% of Medicare Advantage plans.

A further type of Medicare Advantage plan known as a Medicare Medical Savings Account combines high-deductible insurance for Medicare Advantage. It includes a medical savings account (MSA) (M that can be used to pay for Medicare-related costs before the deductible is met. 10% of all Medicare Advantage plans are MSAs.

Prescription drug coverage is typically included in Medicare Advantage plans.

Drug coverage is provided by 71% of Medicare Advantage plans. One of the reasons individuals pick Medicare Advantage plans is the ease with which prescription insurance (Medicare Part D benefits) can be integrated with Original Medicare benefits.

Some people may prefer plan members without drug coverage, such as those with other prescription insurance forms. If you don’t take any prescription medications, you may be tempted to forego paying for prescription drug coverage. Without prescription drug coverage, you could pay the full price for your medications out of pocket. Furthermore, you could incur fees if you enroll in Medicare Part D later.

There are several advantages to hearing, vision, and dental care.

Medicare Advantage plans are progressively offering added benefits in recent years. More than 90% of plans in 2022 include additional benefits, and the majority of them include vision (94%), hearing (99%), and dental coverage (91%).

Insurers also provide numerous discounts and benefits. Today, 92% of plans offer international emergency services, and 91% include exercise programs. Additionally, perks, including transportation (33%), over-the-counter medicine allowances (76%), and telehealth (94%), are being added to plans. Many additionally provide additional assistance for members with more complex medical requirements, in-home assistance, home safety modifications, and gadgets, which are covered by 7% of plans.

There are $0 premiums for over half of the Medicare Advantage plans.

The low monthly rates of many Medicare Advantage plans are an appealing aspect. For Medicare Parts C and D, 54% of people pay no payment. Some of the Medicare Advantage plans usually pay for all or part of your Part B premium, but even those with $0 premiums usually still have to pay for Medicare Parts A and B on their own.

Though, weigh all the costs before selecting a Medicare Advantage plan. Higher deductibles and other out-of-pocket costs may accompany lower rates.

FAQs

Do You Need Medicare Advantage?

Depending on where you reside, you can choose from various Medicare Advantage plans. Before comparing your plan options, you must be aware of your health requirements. Your Medicare Advantage plan must cover your doctor visits and prescription costs.

The sameness of all Medicare Advantage plans

The type of Medicare Advantage coverage you receive depends on where you reside. The cost of a policy might be as little as $0 or as expensive as $300. Each Medicare Advantage Plan is unique. Different deductibles, copayments, and coinsurance conditions may apply to your plan. Although all policies must provide the same level of coverage as Parts A and B, many do so with added advantages. Compare several plans to find which one best suits your needs.

When I sign up for a Medicare Advantage plan, what happens to my Original Medicare plan?

When you sign up for Medicare Advantage, your Original Medicare plan will not be canceled. Medicare Parts A and B are a must before signing up for Medicare Advantage. The commercial insurance provider will manage your Medicare benefits. During the Medicare Open Enrollment Period, also known as the Annual Enrollment Period, you can move from Medicare Advantage to Original Medicare (October 15 through December 7).

While I’m enrolled in a Medicare Advantage plan, can I enroll in a different medication plan?

You can sign up for a different drug plan if your current plan doesn’t cover prescription drugs. Only Medicare Medical Savings Account and Private Fee For Service plans offer a distinct medication plan choice. Before enrolling in a different Part D Plan, carefully examine your current plan. If you enroll in a separate Part D plan while enrolled in a Part C HMO or PPO, Medicare will enroll you in Original Medicare and disenroll you from Part C.

Do I keep paying the Part B premium?

Unless you are eligible for Medicaid, receive assistance from Social Security or your state, or have a plan that reimburses all or part of the premium, you are responsible for continuing to pay your Part B premium.

Visit our website NewMedicare.com to learn more.

Related Posts

Call now to get a Free No Obligation Quote

(TTY 711)

Skip to content