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What is Part C coverage?
Medicare Advantage Plans (like HMOs and PPOs) are sometimes referred to as Medicare Part C. They are private Medicare-approved health plans for those individuals eligible for Medicare. When you join a Medicare Advantage Plan, you are still in Medicare.
Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage and must cover medically necessary services. They generally offer additional benefits, and many include Part D prescription drug coverage. These plans often have networks, which mean you may have to see certain doctors and go to certain hospitals in the plan's network to get care.
Medicare Advantage Plans can save you money, because out-of-pocket costs in these plans are generally lower than with Original Medicare alone. However, your cost will vary by the services you use and the type of plan you purchase. Each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or can use only doctors, facilities, or suppliers in the network).
Plan options can include:
- Preferred Provider Organization (PPO)
- Health Maintenance Organization (HMO)
- Private Fee-For-Service (PFFS)
- Special Needs Plans (SNP)
- Medical Savings Account (MSA)
You can generally join if:
- You live in the service area of the plan you want to join.
- You have Medicare Part A and Part B coverage.
- You don't have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)
Choose your plan carefully, as usually you will only be able to change plans once a year during the Annual Election Period. The Annual Election Period—also called the Open Enrollment Period—is October 15 through December 7.
In past years, Medicare Advantage enrollees had an opportunity to make changes to their coverage from January 1 through March 31. In 2011, the Open Enrollment period for Medicare Advantage Plans was replaced with a Medicare Advantage Disenrollment Period, which runs from January 1 through February 14. During this time, individuals with a Medicare Advantage plan can disenroll from their plan and switch to Original Medicare. They also have until February 14 to join a Part D plan to add prescription drug coverage.