Medicare Part C: Medicare Advantage Plans
Medicare Part C, also known as Medicare Advantage, is an alternative way to receive Medicare benefits. It is offered by private insurance companies approved by Medicare and bundles the coverage of Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Many plans also include Part D (Prescription Drug Coverage) and additional benefits not covered by Original Medicare.
What Medicare Part C Covers
- All Services Covered by Original Medicare
- Prescription Drug Coverage (Part D)
- Additional Benefits
Types of Medicare Advantage Plans
Health Maintenance Organization (HMO):
- Requires you to use doctors and hospitals in the plan’s network.
- Typically requires referrals for specialists.
Preferred Provider Organization (PPO):
- Allows more flexibility to see out-of-network providers but at higher costs.
- No referrals needed for specialists.
Private Fee-for-Service (PFFS):
You can see any Medicare-approved provider, but the provider must accept the plan’s payment terms.
Special Needs Plans (SNPs):
- Tailored for individuals with specific conditions (e.g., chronic illnesses) or needs (e.g., dual eligibility for Medicare and Medicaid).
Medicare Medical Savings Account (MSA):
- High-deductible plan paired with a savings account to pay for healthcare costs.
Eligibility for Medicare Advantage Plans
To qualify for Medicare Part C, you must:
- Be enrolled in Medicare Part A and Part B.
- Live in the plan’s service area.
- Not have End-Stage Renal Disease (ESRD) in most cases (exceptions apply to certain plans).
Costs of Medicare Part C
Monthly Premiums:
- Many Medicare Advantage plans have $0 premiums, but you must still pay the Part B premium ($174.70 in 2025 for most beneficiaries).
- Some plans may charge an additional premium.
Out-of-Pocket Costs:
- Includes deductibles, copayments, or coinsurance for covered services.
- Annual out-of-pocket maximums (e.g., $4,000–$8,300) for Part A and Part B services.
Extra Costs for Additional Benefits:
- Vision, dental, and hearing benefits may have separate copays or limitations.
Medicare Advantage Enrollment Periods
You can enroll in a Medicare Advantage plan during these periods:
Initial Enrollment Period (IEP):
- 7-month window starting 3 months before your 65th birthday month.
Annual Enrollment Period (AEP):
- October 15 to December 7 each year. Coverage begins on January 1.
Medicare Advantage Open Enrollment Period:
- January 1 to March 31. You can switch plans or return to Original Medicare.
Special Enrollment Period (SEP):
- Triggered by qualifying life events, such as moving or losing employer coverage.
Schedule Your FREE Consultation
If you’re ready to take the next step, call 786-970-6539 or e-mail me at topqualitym@gmail.com to book an appointment with me. I proudly serve Florida and can help you find the Medicare coverage you need!