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Medicare Part C

Medicare Part C is also known as Medicare Advantage.

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What is Medicare Part C?

Medicare Part C is also known as Medicare Advantage. It serves as an alternative to original Medicare coverage. While Medicare Part A and Part B are offered by the government through the Centers for Medicare and Medicaid Services, Medicare Advantage plans are sold by private insurance companies that have gotten the approval from Medicare to offer plans to customers. Part C Medicare or Medicare Advantage plans were created as a lower cost option.

As a Medicare enrollee, if you enroll in a Medicare Advantage plan you will be receiving your benefits from a private insurance company instead of Medicare. Medicare Advantage plans are a way to receive Part A and Part B and even Part D drug coverage under one plan. This is because Medicare Part C providers are required to cover all services under Part A and Part B.

Additionally, many Part C plans offer certain benefits that are not available under Original Medicare, such as prescription drug coverage, routine dental, vision, and hearing.

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All you pay for is the premiums, which are the same with or without our help.

Did I see on TV that there are $0 premium plans?

Yes, there might be a $0 premium plan in your area. I bet you are wondering how that can be possible. Medicare pays the Medicare Advantage plans a fee for them to take care of your medical needs. The carrier then decides if they can do it for that amount or if they need to charge more hence some plans have bigger premiums and some are $0. Remember you still need to pay for your Part B in addition to your MedAdvantage plan premium.

Do I still use Medicare Providers?

When you are enrolled in a Medicare Advantage plan you no longer use the Medicare list of providers. Instead you would use the network of providers of the plan you selected. It is very important to see providers in your plans network. Your Medicare Advantage plan could have a provider network that is a HMOs, PPOs, PFFS, SNPs, etc. HMO (Health Maintenance Organization) plans offer healthcare coverage that is restricted to providers that are within the plan’s network. Enrollees who receive coverage out of network may cover the entire cost out of pocket. HMOs also require you to choose a primary care doctor in their network and require you to get a referral to see a specialist.

Preferred Provider Organization Plans (PPO) gives more freedom to their enrollees compared to HMO plans. Under PPO plans, you can receive healthcare services from out of network providers, though it will cost you more. Special Needs Plans (SNPs) are restricted to beneficiaries with certain health conditions.

How to use a Medicare Advantage plan

When you are enrolled in a Medicare Advantage plan you will no longer show your Medicare card. Instead you will show your Medicare Advantage card when receiving services. Your doctor will bill your Medicare Advantage plan instead of Medicare. This is because Medicare is paying that private Medicare Advantage plan to take care of your health needs.

When you are enrolled in an Advantage plan you will pay copays or coinsurance for most services. Once your costs add up to the Maximum out of Pocket amount the insurance company will cover the cost for the rest of the year according to the contract.

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Since Medicare Part C plans are sold by different insurance providers, the plans have different costs. Many Medicare Advantage plans have very low premiums. Generally, Medicare Part C plans have associated costs such as premiums, deductibles, copayments, and coinsurance. The costs vary based on the type of plan, location, provider, and the type of care received. Medicare Advantage plans generally include a yearly out of pocket maximum limit. This puts a cap on the amount of expenses you’ll cover out of pocket within a year.

What Are The Disadvantages of MedAdvantage?

This is one of the first questions people ask when looking into a MedAdvantage plan.

  1. Limited Providers. The biggest downside to Medicare Part C is that your options will be limited to doctors, hospitals, and pharmacies that are in the plan’s network. 

  2. Services for a fee. Since most services have a copay or coinsurance sometimes you can have higher out-of-pocket expenses.

  3. Annual Changes. The benefits, premiums and formulas can change every year. When you are enrolled in a Medicare Advantage Plan you need to review the changes every year to make sure it will still meet your needs. 

  4. Health Questions If down the road you would like to enroll in a Medigap plan you may have to take a health questionnaire and pass in order to enroll in the plan. 


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Questions to Ask Before Choosing a Medicare Advantage Plan

Before choosing a plan, make sure you know

  1. Which hospitals, specialists and pharmacies are a part of the plan’s network
  2. If your plan will cover providers that aren’t in-network
  3. What are the associated costs
    1. Drug plan Deductibles
    2. Copays/ Coinsurance
    3. Maximum out-of-pocket (MOOP) expenses
  4. Does the cost of the services fit into your budget?
  5. Do you need a MA plan or a MAPD plan? MA plans do not include Part D drug coverage. Medicare Advantage Prescription Drug Plans also include Part D drug coverage.

Remember there is no wrong choice between Medicare Advantage Plans and Medigap. Every person has a different budget and health needs. Our Washington agents can help you review your options all for no fees.

Eligibility Requirements

To enroll in Medicare Part C, you need to meet the eligibility requirements. First, you must qualify for Original Medicare and must also be enrolled in the Medicare program. You cannot enroll in Medicare Part C if you do not have Part A and Part B coverage.

Also, to be eligible to enroll in Part C, you must not be currently enrolled in Medicare supplements/Medigap. It is illegal for a Medicare Advantage provider to offer you a Part C plan if you are still enrolled in Medigap.

The initial enrollment period is a seven-month window that allows you to enroll in Original Medicare. You can also enroll in Medicare Part C during the Annual Enrollment period October 15th -December 7th or during a special enrollment period if you qualify for one.

You can also enroll with the 5-star special enrollment period. Medicare gives star ratings to Medicare Advantage plans annually. If a Medicare Advantage Plan with a 5-star rating is available in your area you can use this SEP to enroll in the plan all year long.

Shot of a smiling woman and man standing inside a coffee shop looking at something on their touchscreen
Shot of a smiling woman and man standing inside a coffee shop looking at something on their touchscreen

How to buy a Medicare Advantage Plan

To get a Medicare Advantage plan you can go to Medicare.gov and choose one yourself, or have a broker help you. Either way, you are not charged for finding a plan, so you may as well enlist the help of a broker.

Why Use A Medicare Advantage Broker?

An Independent Medicare Advantage Agent can help you compare costs and needs to make sure the plan you choose is the right option for you. Medicare Insurance Brokers have experience, tools, and access to information that is not readily available to you. This is what we specialize in, so we know the ins and outs of choosing the best Medicare Advantage Plan.

  1. Easier. You can enlist the help of a broker to make the process simpler. A broker will advise you on which plans fulfill your needs now and in the future.
  2. Stay in your budget. Your Medicare Advantage broker will also take you through the Medicare Advantage plans in Washington state that are within your budget.
  3. Faster. Another benefit of working with Medicare Advantage agents in Washington is that you’ll need to spend significantly less time
    1. Researching
    2. Choosing a plan
    3. Completing the enrollment process
  4. Future help. And should you have any questions about your plan later, they’ll be there to help you so you don’t make any mistakes.

McGregor Benefits is an independent health insurance agency in Washington state with a team of experienced Medicare agents. You can explore their profiles online, get their email or phone, and start a conversation directly. If you’re happy with your current plan but need an agent’s help for other reasons, we can help you then as well.

Call one of our licensed independent insurance agents for help today

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